Dataset Information

Prevalence of frailty and association with patient centered outcomes: A prospective registry-embedded cohort study from India.

ABSTRACT:

Purpose

We aimed to study the prevalence of frailty, evaluate risk factors, and understand impact on outcomes in India.

Methods

This was a prospective registry-embedded cohort study across 7 intensive care units (ICUs) and included adult patients anticipated to stay for at least 48 h. Primary exposure was frailty, as defined by a score ≥ 5 on the Clinical Frailty Scale and primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality and resource utilization. We used generalized linear models to evaluate risk factors and model association between frailty and outcomes.

Results

838 patients were included, with median (IQR) age 57 (42,68) yrs.; 64.8% were male. Prevalence of frailty was 19.8%. Charlson comorbidity index (OR:1.73 (95%CI:1.39,2.15)), Subjective Global Assessment categories mild/moderate malnourishment (OR:1.90 (95%CI:1.29, 2.80)) and severe malnourishment (OR:4.76 (95% CI:2.10,10.77)) were associated with frailty. Frailty was associated with higher odds of ICU mortality (adjusted OR:2.04 (95% CI:1.25,3.33)), hospital mortality (adjusted OR:2.36 (95%CI:1.45,3.84)), development of stage2/3 AKI (unadjusted OR:2.35 (95%CI:1.60, 3.43)), receipt of non-invasive ventilation (unadjusted OR:2.68 (95%CI:1.77, 4.03)), receipt of vasopressors (unadjusted OR:1.47 (95%CI:1.04, 2.07)), and receipt of kidney replacement therapy (unadjusted OR:3.15 (95%CI:1.90, 5.17)).

Conclusions

Frailty is common among critically ill patients in India and is associated with worse outcomes.

Study registration

CTRI/2021/02/031503.

SUBMITTER: Tirupakuzhi Vijayaraghavan BK

PROVIDER: S-EPMC10830405 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

Prevalence of frailty and association with patient centered outcomes: A prospective registry-embedded cohort study from India.

Tirupakuzhi Vijayaraghavan Bharath Kumar BK Rashan Aasiyah A Ranganathan Lakshmi L Venkataraman Ramesh R Tripathy Swagata S Jayakumar Devachandran D Ramachandran Pratheema P Mohamed Zubair Umer ZU Balakrishnan Sindhu S Ramakrishnan Nagarajan N Haniffa Rashan R Beane Abi A Adhikari Neill K J NKJ de Keizer Nicolette N Lone Nazir N

Journal of critical care 20231221

<h4>Purpose</h4>We aimed to study the prevalence of frailty, evaluate risk factors, and understand impact on outcomes in India.<h4>Methods</h4>This was a prospective registry-embedded cohort study across 7 intensive care units (ICUs) and included adult patients anticipated to stay for at least 48 h. Primary exposure was frailty, as defined by a score ≥ 5 on the Clinical Frailty Scale and primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality and resource utilization ...[more]

PMID: 38134715

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Project description:ObjectivesThis study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF).BackgroundIn contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF.MethodsOlder hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined.ResultsA total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85).ConclusionsNinety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.

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Dataset Information

Prevalence of frailty and association with patient centered outcomes: A prospective registry-embedded cohort study from India.

Purpose

Methods

Results

Conclusions

Study registration

Publications

Prevalence of frailty and association with patient centered outcomes: A prospective registry-embedded cohort study from India.

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