Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study

Steven A. Frost; Kathleen Brennan; David Sanchez; Joan Lynch; Sonja Hedges; Yu Chin Hou; Masar El Sayfe; Sharon-Ann Shunker; Tony Bogdanovski; Leanne Hunt; Evan Alexandrou; Kaye Rolls; Danielle Ni Chroinin; Anders Aneman

doi:10.1111/aas.14343

Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study

Steven A. Frost, Kathleen Brennan, David Sanchez, Joan Lynch, Sonja Hedges, Yu Chin Hou, Masar El Sayfe, Sharon-Ann Shunker, Tony Bogdanovski, Leanne Hunt, Evan Alexandrou, Kaye Rolls, Danielle Ni Chroinin, Anders Aneman

Western Sydney University

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

Abstract

Background: Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care.Methods: This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented.Results: During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented.Conclusion: We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.

Original language	English
Pages (from-to)	214-225
Number of pages	12
Journal	Acta Anaesthesiologica Scandinavica
Volume	68
Issue number	2
DOIs	https://doi.org/10.1111/aas.14343
Publication status	Published - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Open Access - Access Right Statement

© 2023 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. (http://creativecommons.org/licenses/by/4.0/)

Keywords

frailty
absolute risk prediction
delirium

Access to Document

10.1111/aas.14343

Cite this

Frost, S. A., Brennan, K., Sanchez, D., Lynch, J., Hedges, S., Hou, Y. C., El Sayfe, M., Shunker, S.-A., Bogdanovski, T., Hunt, L., Alexandrou, E., Rolls, K., Chroinin, D. N., & Aneman, A. (2024). Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study. Acta Anaesthesiologica Scandinavica, 68(2), 214-225. https://doi.org/10.1111/aas.14343

@article{7171e5cd80a34bbb9d7f9df6fbc8b766,

title = "Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study",

abstract = "Background: Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care.Methods: This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented.Results: During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented.Conclusion: We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.",

keywords = "frailty, absolute risk prediction, delirium",

author = "Frost, {Steven A.} and Kathleen Brennan and David Sanchez and Joan Lynch and Sonja Hedges and Hou, {Yu Chin} and {El Sayfe}, Masar and Sharon-Ann Shunker and Tony Bogdanovski and Leanne Hunt and Evan Alexandrou and Kaye Rolls and Chroinin, {Danielle Ni} and Anders Aneman",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.",

year = "2024",

month = feb,

doi = "10.1111/aas.14343",

language = "English",

volume = "68",

pages = "214--225",

journal = "Acta Anaesthesiologica Scandinavica",

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Frost, SA, Brennan, K, Sanchez, D, Lynch, J, Hedges, S, Hou, YC, El Sayfe, M, Shunker, S-A, Bogdanovski, T, Hunt, L, Alexandrou, E, Rolls, K, Chroinin, DN & Aneman, A 2024, 'Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study', Acta Anaesthesiologica Scandinavica, vol. 68, no. 2, pp. 214-225. https://doi.org/10.1111/aas.14343

TY - JOUR

T1 - Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study

AU - Frost, Steven A.

AU - Brennan, Kathleen

AU - Sanchez, David

AU - Lynch, Joan

AU - Hedges, Sonja

AU - Hou, Yu Chin

AU - El Sayfe, Masar

AU - Shunker, Sharon-Ann

AU - Bogdanovski, Tony

AU - Hunt, Leanne

AU - Alexandrou, Evan

AU - Rolls, Kaye

AU - Chroinin, Danielle Ni

AU - Aneman, Anders

PY - 2024/2

Y1 - 2024/2

N2 - Background: Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care.Methods: This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented.Results: During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented.Conclusion: We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.

AB - Background: Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care.Methods: This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented.Results: During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented.Conclusion: We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.

KW - frailty

KW - absolute risk prediction

KW - delirium

UR - https://hdl.handle.net/1959.7/uws:74704

UR - http://www.scopus.com/inward/record.url?scp=85175483446&partnerID=8YFLogxK

U2 - 10.1111/aas.14343

DO - 10.1111/aas.14343

M3 - Article

SN - 1399-6576

SN - 0001-5172

VL - 68

SP - 214

EP - 225

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 2

ER -

Frailty in the prediction of delirium in the intensive care unit : a secondary analysis of the Deli study

Abstract

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Keywords

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