Long term outcomes in the critically ill: Investigating the association between frailty and survival. LONG a SWARM regional observational study

Abstract

Background: Frailty is common and is present in up to 30% of patients admitted to the ICU. We do not yet understand the true impact of ICU admission on this population, certainly in terms of longer-term outcomes. Method: Random selection of patients admitted to each general ICU within the SWARM network between October 1st 2012 and January 31st 2013. To be eligible, patients had to be over the age of 18 and admitted to the ICU with either a medical diagnosis or following emergency gastrointestinal/vascular surgery. Results: 1888 patients were eligible for random selection. 560 patients were selected for the final analysis. Three hundred and eighteen patients had an estimated frailty score between 1 and 3 (classified as not frail, 56.8%), whilst 112 had a score of 4 (classified as vulnerable, 20%) and 130 patients had a score of between 5 and 7 (classified as frail, 23.2%). The median survival for patients with an estimated frailty score of four (vulnerable) was lower than those with an estimated score of 5 or greater (331.5 vs 594 days, p < 0.0001). One-year survival was 79% (75, 84), whilst 5-year survival was 69% (65, 75). Hazard ratios for ‘vulnerable’ and ‘frail’ sub-groups were estimated as 2.6 and 2.4 respectively. Conclusion: There is significant evidence to suggest a strong causal association between frailty and survival after ICU admission. ‘Vulnerable’ status may well be associated with similar effect on long-term survival to that of ‘frailty’.