Frailty status among older critically ill patients with severe acute kidney injury
Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of old...
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-021-03510-y |
| _version_ | 1828896753752997888 |
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| author | William Beaubien-Souligny Alan Yang Gerald Lebovic Ron Wald Sean M. Bagshaw |
| author_facet | William Beaubien-Souligny Alan Yang Gerald Lebovic Ron Wald Sean M. Bagshaw |
| author_sort | William Beaubien-Souligny |
| collection | DOAJ |
| description | Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year. |
| first_indexed | 2024-12-13T14:46:19Z |
| format | Article |
| id | doaj.art-f5a1c159705741e5a42423e39fc3c8a3 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-13T14:46:19Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-f5a1c159705741e5a42423e39fc3c8a32022-12-21T23:41:28ZengBMCCritical Care1364-85352021-02-0125111010.1186/s13054-021-03510-yFrailty status among older critically ill patients with severe acute kidney injuryWilliam Beaubien-Souligny0Alan Yang1Gerald Lebovic2Ron Wald3Sean M. Bagshaw4Division of Nephrology, Centre Hospitalier de L’Université de MontréalApplied Health Research Centre, St. Michael’s HospitalApplied Health Research Centre, St. Michael’s HospitalDivision of Nephrology, St. Michael’s Hospital and University of TorontoDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of AlbertaAbstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.https://doi.org/10.1186/s13054-021-03510-yAcute kidney injuryFrailtyRenal replacement therapyPatient-oriented outcomesAgingFunctional status |
| spellingShingle | William Beaubien-Souligny Alan Yang Gerald Lebovic Ron Wald Sean M. Bagshaw Frailty status among older critically ill patients with severe acute kidney injury Critical Care Acute kidney injury Frailty Renal replacement therapy Patient-oriented outcomes Aging Functional status |
| title | Frailty status among older critically ill patients with severe acute kidney injury |
| title_full | Frailty status among older critically ill patients with severe acute kidney injury |
| title_fullStr | Frailty status among older critically ill patients with severe acute kidney injury |
| title_full_unstemmed | Frailty status among older critically ill patients with severe acute kidney injury |
| title_short | Frailty status among older critically ill patients with severe acute kidney injury |
| title_sort | frailty status among older critically ill patients with severe acute kidney injury |
| topic | Acute kidney injury Frailty Renal replacement therapy Patient-oriented outcomes Aging Functional status |
| url | https://doi.org/10.1186/s13054-021-03510-y |
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