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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, Spain.
Insights
Frailty assessment improves mortality prediction in elderly patients after digestive surgery. Combining frailty measures with APACHE II enhances in-hospital and 6-month survival predictions, but not ICU mortality.
Area of Science:
- Geriatric Medicine
- Surgical Critical Care
- Prognostic Modeling
Background:
- Predicting mortality in elderly patients undergoing digestive surgery is crucial.
- Existing scoring systems like APACHE II have limitations in capturing patient vulnerability.
Purpose of the Study:
- To evaluate if frailty assessment enhances mortality prediction in ICU patients post-digestive surgery.
- To compare the predictive power of frailty indices alone and in combination with APACHE II.
Main Methods:
- Prospective observational study of 92 elderly patients admitted to a surgical ICU.
- Frailty assessed using the Clinical Frailty Scale and modified Frailty Index.
- Mortality analyzed at ICU discharge, in-hospital, and at 6 months, compared with APACHE II scores.
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 indices combined showed strong 6-month mortality prediction (AUC: 0.84).
Conclusions:
- Frailty assessment complements APACHE II for predicting in-hospital mortality after digestive surgery.
- Frailty is a significant predictor of 6-month mortality in this cohort.
- Frailty does not improve ICU mortality prediction when APACHE II is used alone.
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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