The FRAIL scale independently predicts 28-day mortality in critically ill older adults: a prospective comparison with...

Frailty is a multidimensional syndrome associated with adverse outcomes in older adults. This study aimed to compare the predictive value of the FRAIL scale and the Clinical Frailty Scale (CFS) for 28-day mortality among critically ill geriatric patients.

In this prospective cohort study conducted in a tertiary intensive care unit, all consecutive patients aged ≥65 years were assessed for frailty at intensive care unit admission using the FRAIL scale and the CFS. Logistic regression analysis was performed to identify independent associations with 28-day mortality. Receiver operating characteristic analyses with DeLong comparison and Kaplan-Meier survival analyses with log-rank testing were also performed.

Among 168 patients, 53% were male, and the median age was 77 years (IQR 70-82). The 28-day mortality rate was significantly higher in frail patients compared with non-frail patients according to both the FRAIL scale (36% vs. 16%, p = 0.005) and CFS (34% vs. 15%, p = 0.009). Agreement between the two tools was good (κ = 0.75; 95% CI, 0.65-0.85). In multivariable analysis, frailty defined by the FRAIL scale remained independently associated with 28-day mortality (OR 2.41; 95% CI, 1.01-5.76; p = 0.048), whereas CFS-based frailty was not (OR 2.26; 95% CI, 0.91-5.63; p = 0.080). The AUROC values for total scores were 0.664 for the FRAIL scale and 0.700 for the CFS (DeLong p = 0.149); for dichotomized frailty status, AUROC values were 0.620 and 0.606, respectively (DeLong p = 0.595).

Frailty at ICU admission is an important predictor of short-term mortality in older adults. The FRAIL scale demonstrated independent prognostic value in the primary adjusted model, while AUROC comparison did not show a statistically significant discrimination advantage over the CFS.