Frailty status among older critically ill patients with severe acute kidney injury

Critical Care

Alan Yang¹  Gerald Lebovic¹  Sean M. Bagshaw²  William Beaubien-Souligny³  Ron Wald⁴ 

[1] Applied Health Research Centre, St. Michael’s Hospital, Toronto, Canada;Department of Critical Care Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street, T6G2B7, Edmonton, AB, Canada;Division of Nephrology, Centre Hospitalier de L’Université de Montréal, Montreal, Canada;Division of Nephrology, St. Michael’s Hospital and University of Toronto, Toronto, Canada;

关键词: Acute kidney injury;    Frailty;    Renal replacement therapy;    Patient-oriented outcomes;    Aging;    Functional status;    Quality of life;   

DOI  :  10.1186/s13054-021-03510-y

来源: Springer

【 摘 要 】

BackgroundFrailty 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.MethodsThis 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.ResultsAmong 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).ConclusionsPre-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.

【 授权许可】

CC BY