Enhancing Delirium Prediction in ICU Older Patients Through the 5-Factor Modified Frailty Index

Delirium and frailty are prevalent in the ICU, yet there is a paucity of research utilising frailty as determined by the 5-factor modified frailty index (mFI-5) to examine its correlation with delirium in intensive care unit (ICU) older patients.

The aim of this research was to explore the association between the mFI-5 and the occurrence of delirium in older patients admitted to the ICU, while assessing the mFI-5's predictive value for delirium.

This study employed data extracted from the Medical Information Mart for Intensive Care IV database. The participants were classified into three groups based on their mFI-5 scores: non-frail (mFI-5 = 0), intermediate frailty (mFI-5 = 1) and high frailty (mFI-5 ≥ 2). The predictive value of mFI-5 for delirium was evaluated using the area under the curve, the net reclassification improvement and the integrated discrimination improvement metrics.

Delirium was observed in 9919 of the 30 280 patients included in the study. Patients with intermediate frailty (adjusted odds ratios [OR]: 1.38, 95% CI: 1.28-1.48, p < 0.001) and high frailty (adjusted OR: 1.83, 95% CI: 1.69-1.97, p < 0.001) exhibited a markedly elevated risk of delirium in comparison to non-frail patients. Furthermore, the incorporation of the mFI-5 into the multivariate model markedly enhanced its predictive accuracy for delirium.

Frailty as assessed by the mFI-5 is strongly correlated with an elevated risk of delirium in older ICU patients. The incorporation of the mFI-5 into delirium prediction models may enhance the predictive accuracy of these models.

The mFI-5 is a valuable tool for identifying older ICU patients at higher risk of delirium, aiding in early intervention and tailored care.