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Association between frailty, delirium, and mortality in older critically ill patients: a binational registry study
journal contribution
posted on 2023-02-06, 23:12 authored by Berhe Sahle, D Pilcher, E Litton, R Ofori-Asenso, K Peter, J McFadyen, Tracey BucknallTracey BucknallAbstract
Background
Frailty and delirium are prevalent among older adults admitted to the intensive care unit (ICU) and associated with adverse outcomes; however, their relationships have not been extensively explored. This study examined the association between frailty and mortality and length of hospital stay (LOS) in ICU patients, and whether the associations are mediated or modified by an episode of delirium.
Methods
Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 149,320 patients aged 65 years or older admitted to 203 participating ICUs between 1 January 2017 and 31 December 2020 who had data for frailty and delirium were included in the analysis.
Results
A total of 41,719 (27.9%) older ICU patients were frail on admission, and 9,179 patients (6.1%) developed delirium during ICU admission. Frail patients had significantly higher odds of in-hospital mortality (OR: 2.15, 95% CI 2.05–2.25), episodes of delirium (OR: 1.86, 95% CI 1.77–1.95), and longer LOS (log-transformed mean difference (MD): 0.24, 95% CI 0.23–0.25). Acute delirium was associated with 32% increased odds of in-hospital mortality (OR: 1.32, 95% CI 1.23–1.43) and longer LOS (MD: 0.54, 95% CI 0.50–0.54). The odds ratios (95% CI) for in-hospital mortality were 1.37 (1.23–1.52), 2.14 (2.04–2.24) and 2.77 (2.51–3.05) for non-frail who developed delirium, frail without delirium, and frail and developed delirium during ICU admission, respectively. There was very small but statistically significant effect of frailty on in-hospital mortality (b for indirect effect: 0.00037, P < 0.001) and LOS (b for indirect effect: 0.019, P < 0.001) mediated through delirium.
Conclusion
Both frailty and delirium independently increase the risk of in-hospital mortality and LOS. Acute delirium is more common in frail patients; however, it does not mediate or modify a clinically meaningful amount of the association between frailty and in-hospital mortality and LOS.
History
Journal
Annals of Intensive CareVolume
12Article number
108Pagination
1-8Location
Berlin, GermanyPublisher DOI
ISSN
2110-5820eISSN
2110-5820Language
EnglishPublication classification
C1 Refereed article in a scholarly journalIssue
1Publisher
SpringerUsage metrics
Keywords
CAREClinical decision-makingCritical Care MedicineCritically illDeliriumFrailtyGeneral & Internal MedicineICUIMPACTIntensive care unitLength of stayLEVELLife Sciences & BiomedicineMortalityOUTCOMESScience & TechnologyAgingPatient SafetyClinical Research3 Good Health and Well BeingPublic Health and Health Services not elsewhere classifiedClinical Sciences not elsewhere classified
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