Fragilidad en pacientes mayores de 65 años ingresados en cuidados intensivos (FRAIL-ICU) / Frailty in patients over 65 years of age admitted to Intensive Care Units (FRAIL-ICU)

RESUMEN

Objetivo: Estimar la prevalencia de fragilidad en pacientes ingresados en cuidados intensivos (UCI) y su impacto sobre la mortalidad intra UCI, al mes y a los 6 meses. Diseño: Estudio de cohorte prospectiva. Ámbito UCI polivalentes españolas. Intervención Ninguna. Pacientes y métodos: Pacientes≥65 años ingresados en UCI>24horas. Se recogieron las variables al ingreso y la situación basal por teléfono al mes y a los 6 meses del alta de UCI. Variables de interés principal Edad, sexo, fragilidad (escala FRAIL), situación basal (Barthel, Lawton, Clinical Dementia Rating y Nutric Score), días de ventilación mecánica (VM), escalas de gravedad (APACHE II y SOFA), mortalidad UCI, al mes y a los 6 meses del alta. Resultados: Ciento treinta y dos pacientes, 46 frágiles (34,9%). Pacientes frágiles vs. no frágiles 78,8±7,2 vs. 78,6±6,4 años (p=0,43), varones 43,8% vs. 56,3% (p=0,10), SOFA 4,7±2,9 vs. 4,6±2,9 (p=0,75), VM 33.3% vs. 66,7% (p=0,75), días de VM 5,6±15 vs. 4,3±8,1 (p=0,57), mortalidad UCI 13% versus 6% (p = 0,14), mortalidad al mes 24% versus 8% (p = 0,01), mortalidad 6 meses 32% versus 15% (p = 0,03). La fragilidad se asocia con la mortalidad al mes (OR = 3,5; p <0,05, IC del 95% (1,22-10,03) y a los 6 meses del alta de UCI (OR = 2,62; p <0,05, IC del 95% (1,04-6,56). Conclusiones: La fragilidad está presente en el 35% de los pacientes ingresados en UCI, asociándose a la mortalidad

ABSTRACT

Objective: To estimate the prevalence of frailty in patients admitted to the Intensive Care Unit (ICU) and its impact upon ICU mortality at 1 and 6 months. Design: A prospective observational cohort study was carried out. Setting: Spanish ICU. Intervention None. Patients and methods: Patients≥65 years of age admitted to the ICU for>24hours. Variables were registered upon admission, and functional status was assessed by telephone calls 1 and 6 months after discharge from the ICU. Main study variables Age, gender, frailty (FRAIL scale), functional status (Barthel, Lawton, Clinical Dementia Rating and NUTRIC score), days of mechanical ventilation (MV), functional score (APACHE II and SOFA), ICU mortality, and mortality 1 and 6 months after ICU discharge. Results: A total of 132 patients were evaluated, of which 46 were frail (34.9%). Age of the frail versus non-frail patients 78.8±7.2 and 78.6±6.4 years, respectively (P=.43); male gender 43.8% versus 56.3% (P=.10); SOFA score 4.7±2.9 versus 4.6±2.9 (P=.75); MV 33.3% versus 66.7% (P=.75); days of MV 5.6±15 versus 4.3±8.1 (P=.57); ICU mortality 13% versus 6% (P = .14), mortality at 1 month 24% versus 8% (P = .01), mortality 6 months 32% versus 15% (P = .03). Frailty is associated with mortality at one month (OR = 3.5, P <.05, 95% CI (1.22-10.03) and at 6 months after discharge from the ICU (OR = 2.62, P <.05, 95% CI (1.04-6.56). Conclusions: Frailty was present in 35% of the patients admitted to the ICU, and was associated with mortality