1. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study
- Author
-
Mirosław Ziętkiewicz, Anna Kluzik, Maurizio Cecconi, Wojciech Szczeklik, Finn H. Andersen, Richard Pugh, Jesper Fjølner, Stefania Brusa, Christoffer Sølling, Muhammed K Elhadi Elfaituri, Malgorzata Lipinska-Gediga, Tom Lawton, Ihor Yovenko, Nikoletta Rovina, Ioannis Koutsodimitropoulos, Miroslaw Czuczwar, Joerg C. Schefold, Prof. Ignacio Martin-loeches, Hubert Hymczak, Ingeborg Welters, Dylan De Lange, Sally Humphreys, Jean-Pierre QUENOT, Alexander Cornet, David Perez-Torres, Christian Jung, Stefan Schaller, Artigas Antonio, Willem Dieperink, Marcela Vizcaychipi, Walter Swinnen, Ariane Boumendil, Maciej Zukowski, Muhammed Elhadi, Critical Care, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
- Subjects
Male ,Activities of daily living ,Outcome Assessment ,Original ,intensive care units ,HSJ UCI ,Kaplan-Meier Estimate ,Comorbidity ,Critical Care and Intensive Care Medicine ,Cognitive functioning ,law.invention ,intensive care afdelingen ,0302 clinical medicine ,Elderly ,Comorbidity/trends ,law ,kwetsbaarheid ,Prevalence ,80 and over ,Medicine ,Prospective Studies ,Cognitive decline ,Prospective cohort study ,610 Medicine & health ,Outcome Assessment, Health Care/statistics & numerical data ,Cognition/physiology ,Outcome ,Aged, 80 and over ,Frailty ,Intensive care unit ,Europe ,Intensive Care Units/statistics & numerical data ,Female ,medicine.medical_specialty ,Health Care/statistics & numerical data ,80 jaar en ouder ,frailty ,Frailty/psychology ,elderly ,03 medical and health sciences ,Informant Questionnaire on Cognitive Decline in the Elderly ,Internal medicine ,ouderen ,Journal Article ,Humans ,Aged ,Hospitalization/statistics & numerical data ,Proportional Hazards Models ,Polypharmacy ,Activities of Daily Living/classification ,Intensive Care Units/organization & administration ,business.industry ,Proportional hazards model ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,030208 emergency & critical care medicine ,medicine.disease ,critical care ,Critical care ,030228 respiratory system ,Intensive Care Units/standards ,kritieke zorg ,Frailty/complications ,Multivariate Analysis ,business ,Prediction - Abstract
Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients’ characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike’s information criterion across imputations was used to evaluate the goodness of fit of our models. Results We included 3920 patients with a median age of 84 years (IQR: 81–87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83–8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3–6); IQCODE: 3.19 (3–3.69); ADL: 6 (4–6); Comorbidity and Polypharmacy score (CPS): 10 (7–14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.–1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14–1.17, p
- Published
- 2020