Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study

David Sanchez; Kathleen Brennan; Masar Al Sayfe; Sharon-Ann Shunker; Tony Bogdanoski; Sonja Hedges; Yu Chin Hou; Joan Lynch; Leanne Hunt; Evan Alexandrou; Manoj Saxena; Simon Abel; Ramanathan Lakshmanan; Deepak Bhonagiri; Michael J. Parr; Anders Aneman; Danielle Ni Chroinin; Kenneth M. Hillman; Steven A. Frost

doi:10.1186/s13054-020-03318-2

Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study

David Sanchez, Kathleen Brennan, Masar Al Sayfe, Sharon-Ann Shunker, Tony Bogdanoski, Sonja Hedges, Yu Chin Hou, Joan Lynch, Leanne Hunt, Evan Alexandrou, Manoj Saxena, Simon Abel, Ramanathan Lakshmanan, Deepak Bhonagiri, Michael J. Parr, Anders Aneman, Danielle Ni Chroinin, Kenneth M. Hillman, Steven A. Frost

Western Sydney University

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50ÃÂ years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results: During the 6-month baseline period, 997 patients, aged 50ÃÂ years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

Original language	English
Article number	609
Number of pages	8
Journal	Critical Care
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s13054-020-03318-2
Publication status	Published - 2020

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Sanchez, D., Brennan, K., Al Sayfe, M., Shunker, S.-A., Bogdanoski, T., Hedges, S., Hou, Y. C., Lynch, J., Hunt, L., Alexandrou, E., Saxena, M., Abel, S., Lakshmanan, R., Bhonagiri, D., Parr, M. J., Aneman, A., Ni Chroinin, D., Hillman, K. M., & Frost, S. A. (2020). Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study. Critical Care, 24(1), Article 609. https://doi.org/10.1186/s13054-020-03318-2

@article{444b16d9edce426388df1b9006b9e346,

title = "Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study",

abstract = "Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50{\~A}{\^A} years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results: During the 6-month baseline period, 997 patients, aged 50{\~A}{\^A} years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.",

author = "David Sanchez and Kathleen Brennan and {Al Sayfe}, Masar and Sharon-Ann Shunker and Tony Bogdanoski and Sonja Hedges and Hou, {Yu Chin} and Joan Lynch and Leanne Hunt and Evan Alexandrou and Manoj Saxena and Simon Abel and Ramanathan Lakshmanan and Deepak Bhonagiri and Parr, {Michael J.} and Anders Aneman and {Ni Chroinin}, Danielle and Hillman, {Kenneth M.} and Frost, {Steven A.}",

year = "2020",

doi = "10.1186/s13054-020-03318-2",

language = "English",

volume = "24",

journal = "Critical Care",

issn = "1466-609X",

publisher = "BioMed Central",

number = "1",

}

Sanchez, D, Brennan, K, Al Sayfe, M, Shunker, S-A, Bogdanoski, T, Hedges, S, Hou, YC , Lynch, J , Hunt, L, Alexandrou, E, Saxena, M, Abel, S, Lakshmanan, R, Bhonagiri, D, Parr, MJ, Aneman, A, Ni Chroinin, D, Hillman, KM & Frost, SA 2020, 'Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study', Critical Care, vol. 24, no. 1, 609. https://doi.org/10.1186/s13054-020-03318-2

TY - JOUR

T1 - Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study

AU - Sanchez, David

AU - Brennan, Kathleen

AU - Al Sayfe, Masar

AU - Shunker, Sharon-Ann

AU - Bogdanoski, Tony

AU - Hedges, Sonja

AU - Hou, Yu Chin

AU - Lynch, Joan

AU - Hunt, Leanne

AU - Alexandrou, Evan

AU - Saxena, Manoj

AU - Abel, Simon

AU - Lakshmanan, Ramanathan

AU - Bhonagiri, Deepak

AU - Parr, Michael J.

AU - Aneman, Anders

AU - Ni Chroinin, Danielle

AU - Hillman, Kenneth M.

AU - Frost, Steven A.

PY - 2020

Y1 - 2020

N2 - Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50ÃÂ years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results: During the 6-month baseline period, 997 patients, aged 50ÃÂ years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

AB - Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50ÃÂ years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results: During the 6-month baseline period, 997 patients, aged 50ÃÂ years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

UR - https://hdl.handle.net/1959.7/uws:62569

U2 - 10.1186/s13054-020-03318-2

DO - 10.1186/s13054-020-03318-2

M3 - Article

SN - 1466-609X

VL - 24

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 609

ER -

Frailty, delirium and hospital mortality of older adults admitted to intensive care : the Delirium (Deli) in ICU study

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