PMID- 38091131
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231216
IS  - 2110-5820 (Print)
IS  - 2110-5820 (Electronic)
IS  - 2110-5820 (Linking)
VI  - 13
IP  - 1
DP  - 2023 Dec 13
TI  - Frailty's influence on 30-day mortality in old critically ill ICU patients: a 
      bayesian analysis evaluating the clinical frailty scale.
PG  - 126
LID - 10.1186/s13613-023-01223-9 [doi]
LID - 126
AB  - INTRODUCTION: Frailty is widely acknowledged as influencing health outcomes among 
      critically ill old patients. Yet, the traditional understanding of its impact has 
      predominantly been through frequentist statistics. We endeavored to explore this 
      association using Bayesian statistics aiming to provide a more nuanced 
      understanding of this multifaceted relationship. METHODS: Our analysis 
      incorporated a cohort of 10,363 older (median age 82 years) patients from three 
      international prospective studies, with 30-day all-cause mortality as the primary 
      outcome. We defined frailty as Clinical Frailty Scale >/= 5. A hierarchical 
      Bayesian logistic regression model was employed, adjusting for covariables, using 
      a range of priors. An international steering committee of registry members 
      reached a consensus on a minimal clinically important difference (MCID). RESULTS: 
      In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 
      51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 
      1.60 (95% CI 1.45-1.76). Frailty was invariably linked to adverse outcomes 
      (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal 
      clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale 
      (CFS) as a continuous variable, the median OR was 1.19 (1.16-1.22), with over 99% 
      probability of the effect being more significant than 1.5 times the MCID. Frailty 
      remained outside the region of practical equivalence (ROPE) in all analyses, 
      underscoring its clinical importance regardless of how it is measured. 
      CONCLUSIONS: This research demonstrates the significant impact of frailty on 
      short-term mortality in critically ill elderly patients, particularly when the 
      Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, 
      which views frailty as a spectrum, enables more effective, personalized care for 
      this vulnerable group. Significantly, frailty was consistently outside the region 
      of practical equivalence (ROPE) in our analysis, highlighting its clinical 
      importance.
CI  - (c) 2023. The Author(s).
FAU - Wernly, Bernhard
AU  - Wernly B
AD  - Institute of General Practice, Family Medicine and Preventive Medicine, 
      Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.
AD  - Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of 
      the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria.
FAU - Bruno, Raphael Romano
AU  - Bruno RR
AD  - Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, 
      Heinrich-Heine-University Duesseldorf, 40225, Dusseldorf, Germany.
FAU - Beil, Michael
AU  - Beil M
AD  - Department of Medical Intensive Care, Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel.
FAU - Flaatten, Hans
AU  - Flaatten H
AD  - Department of Clinical Medicine, University of Bergen, Department of Anaestesia 
      and Intensive Care, Haukeland University Hospital, 5021, Bergen, Norway.
FAU - Kelm, Malte
AU  - Kelm M
AD  - Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, 
      Heinrich-Heine-University Duesseldorf, 40225, Dusseldorf, Germany.
AD  - Cardiovascular Research Institute Dusseldorf (CARID), Medical Faculty, 
      Heinrich-Heine University, Duesseldorf, Germany.
FAU - Sigal, Sviri
AU  - Sigal S
AD  - Department of Medical Intensive Care, Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel.
FAU - Szczeklik, Wojciech
AU  - Szczeklik W
AD  - Center for Intensive Care and Perioperative Medicine, Jagiellonian University 
      Medical College, 31-008, Krakow, Poland.
FAU - Elhadi, Muhammed
AU  - Elhadi M
AD  - Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya.
FAU - Joannidis, Michael
AU  - Joannidis M
AD  - Division of Intensive Care and Emergency Medicine, Department of Internal 
      Medicine, Medical University Innsbruck, 6020, Innsbruck, Austria.
FAU - Kokofer, Andreas
AU  - Kokofer A
AD  - Department of Anaesthesiology, Perioperative Medicine and Intensive Care, 
      Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.
FAU - Oeyen, Sandra
AU  - Oeyen S
AD  - Department of Intensive Care 1K12IC, Ghent University Hospital, 9000, Ghent, 
      Belgium.
FAU - Marsh, Brian
AU  - Marsh B
AD  - Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland.
FAU - Moreno, Rui
AU  - Moreno R
AD  - Centro Hospitalar de Lisboa Central, Faculdade de Ciencias Medicas de Lisboa, 
      Nova Medical School, Lisboa, Portugal.
AD  - Faculdade de Ciencias da Saude, Universidade da Beira Interior, Covilha, 
      Portugal.
FAU - Wernly, Sarah
AU  - Wernly S
AD  - Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of 
      the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria.
FAU - Leaver, Susannah
AU  - Leaver S
AD  - General Intensive Care, St. George S University Hospital NHS Foundation Trust, 
      London, SW17 0QT, UK.
FAU - De Lange, Dylan W
AU  - De Lange DW
AD  - Department of Intensive Care Medicine, University Medical Center, University 
      Utrecht, 3584 CX, Utrecht, Utrecht, The Netherlands.
FAU - Guidet, Bertrand
AU  - Guidet B
AD  - Inserm, Service de'Reanimation, Sorbonne Universite, Hopital Saint-Antoine, 
      Institut Pierre-Louis d'epidemiologie Et de Sante Publique, AP-HP, 184, Rue du 
      Faubourg-Saint-Antoine, 75012, Paris, France.
FAU - Jung, Christian
AU  - Jung C
AUID- ORCID: 0000-0001-8325-250X
AD  - Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, 
      Heinrich-Heine-University Duesseldorf, 40225, Dusseldorf, Germany. 
      christian.jung@med.uni-duesseldorf.de.
AD  - Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya. 
      christian.jung@med.uni-duesseldorf.de.
AD  - Division of Cardiology, Pulmonology and Vascular Medicine, University 
      Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany. 
      christian.jung@med.uni-duesseldorf.de.
LA  - eng
PT  - Journal Article
DEP - 20231213
PL  - Germany
TA  - Ann Intensive Care
JT  - Annals of intensive care
JID - 101562873
PMC - PMC10719192
COIS- We have no conflicts of interest to disclose.
EDAT- 2023/12/13 18:42
MHDA- 2023/12/13 18:43
PMCR- 2023/12/13
CRDT- 2023/12/13 13:31
PHST- 2023/10/16 00:00 [received]
PHST- 2023/12/05 00:00 [accepted]
PHST- 2023/12/13 18:43 [medline]
PHST- 2023/12/13 18:42 [pubmed]
PHST- 2023/12/13 13:31 [entrez]
PHST- 2023/12/13 00:00 [pmc-release]
AID - 10.1186/s13613-023-01223-9 [pii]
AID - 1223 [pii]
AID - 10.1186/s13613-023-01223-9 [doi]
PST - epublish
SO  - Ann Intensive Care. 2023 Dec 13;13(1):126. doi: 10.1186/s13613-023-01223-9.