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Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after
P Ruiz de Gopegui Miguelena1, M T Martínez Lamazares1, L M Claraco Vega1
1Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España.
Insights
Frailty assessment, using the Clinical Frailty Scale and Frailty Index, improves mortality prediction in ICU patients over 70 after digestive surgery. Frailty complements APACHE II for hospital and 6-month mortality, but not ICU mortality.
Area of Science:
- Critical Care Medicine
- Geriatric Surgery
- Surgical Outcomes Research
Background:
- Predicting mortality in elderly patients undergoing digestive surgery is crucial.
- The APACHE II score is a standard severity assessment tool.
- The role of frailty in predicting outcomes after ICU admission for digestive surgery requires further investigation.
Purpose of the Study:
- To determine if frailty assessment enhances mortality prediction in ICU patients post-digestive surgery.
- To compare the predictive power of frailty measures against the APACHE II score.
Main Methods:
- A prospective, observational study followed 92 ICU patients (over 70) after digestive surgery.
- Frailty was assessed using the Clinical Frailty Scale and modified Frailty Index.
- APACHE II, ICU, in-hospital, and 6-month mortality were recorded.
Main Results:
- APACHE II alone best predicted ICU mortality (AUC: 0.89).
- Combining APACHE II with the Clinical Frailty Scale improved in-hospital mortality prediction (AUC: 0.82 vs. 0.78).
- Frailty measures (Clinical Frailty Scale and Frailty Index) effectively predicted 6-month mortality (AUC: 0.84).
Conclusions:
- Frailty assessment complements the APACHE II score for predicting hospital and 6-month mortality in this patient group.
- Frailty does not improve ICU mortality prediction, where APACHE II alone is highly effective.
- Frailty is a significant independent predictor of longer-term mortality post-digestive surgery.
Objective:
To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery.
Design:
Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019.
Setting:
Surgical ICU of a third level hospital.
Patients:
Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months.
Interventions:
Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index.
Main Variables Of Interest:
ICU, in-hospital and 6-month mortality.
Results:
The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84).
Conclusions:
Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.
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