Sex-specific prevalence and outcomes of frailty in critically ill patients
Abstract Background The prevalence of frailty, an important risk factor for short- and long-term outcomes in hospitalized adults, differs by sex. Studies in critically ill adults have also found differences in mortality and organ support rates in males and females. The objective of this study was to...
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doaj-e22887af4f93487990dab880baffccce2020-11-25T02:47:52ZengBMCJournal of Intensive Care2052-04922020-09-01811810.1186/s40560-020-00494-9Sex-specific prevalence and outcomes of frailty in critically ill patientsErin Hessey0Carmel Montgomery1Danny J. Zuege2Darryl Rolfson3Henry T. Stelfox4Kirsten M. Fiest5Sean M. Bagshaw6Department of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services–Edmonton Zone, University of AlbertaDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services–Edmonton Zone, University of AlbertaDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services–Calgary ZoneDivision of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of AlbertaDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services–Calgary ZoneDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services–Calgary ZoneDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry and Alberta Health Services–Edmonton Zone, University of AlbertaAbstract Background The prevalence of frailty, an important risk factor for short- and long-term outcomes in hospitalized adults, differs by sex. Studies in critically ill adults have also found differences in mortality and organ support rates in males and females. The objective of this study was to determine if these observed differences in mortality and organ support rates can be explained by sex and frailty alone, or if the interaction between sex and frailty is an important risk factor. Methods This is a retrospective multi-centre population-based cohort study of all adult patients (≥ 18 years) admitted to the seventeen intensive care units (ICUs) across Alberta, Canada, between 2016 and 2017. On admission, physicians assigned a Clinical Frailty Scale (CFS) score (1 = very fit, 9 = terminally ill) to all patients. Patients with missing CFS scores or who died within 24 h of ICU admission were excluded. Frailty was defined as CFS ≥ 5. Outcomes included all-cause hospital mortality, ICU mortality, and organ support rates. A propensity score for female sex was generated and 1:1 matching on sex was performed. Multivariable Cox regression or logistic regression, as appropriate, was performed to evaluate the association between sex, frailty, and the sex-frailty interaction term with outcomes. Results Of 15,238 patients included in the cohort, after propensity score matching 11,816 patients remained (mean [standard deviation] age 57.3 [16.9]). In the matched cohort, females had a higher prevalence of frailty than males (32% vs. 27%, respectively) and higher odds of frailty (odds ratio [95% confidence interval (CI)] 1.29 [1.20–1.40]). Though females were less likely to receive invasive mechanical ventilation (hazard ratio [95% CI] 0.78 [0.71–0.86]), the interaction between sex and frailty (i.e., males and females with and without frailty) was not associated with differences in organ support rates. Receipt of dialysis and vasoactive support, as well as hospital mortality and ICU mortality were associated with frailty but were not associated with female sex or the interaction between sex and frailty. Conclusions Although frailty and sex were individually associated with mortality and differences in organ support in the ICU, there does not appear to be a significant interaction between sex and frailty with regards to these outcomes.http://link.springer.com/article/10.1186/s40560-020-00494-9FrailtySexFemaleCritical careMortalityMechanical ventilation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Erin Hessey Carmel Montgomery Danny J. Zuege Darryl Rolfson Henry T. Stelfox Kirsten M. Fiest Sean M. Bagshaw |
spellingShingle |
Erin Hessey Carmel Montgomery Danny J. Zuege Darryl Rolfson Henry T. Stelfox Kirsten M. Fiest Sean M. Bagshaw Sex-specific prevalence and outcomes of frailty in critically ill patients Journal of Intensive Care Frailty Sex Female Critical care Mortality Mechanical ventilation |
author_facet |
Erin Hessey Carmel Montgomery Danny J. Zuege Darryl Rolfson Henry T. Stelfox Kirsten M. Fiest Sean M. Bagshaw |
author_sort |
Erin Hessey |
title |
Sex-specific prevalence and outcomes of frailty in critically ill patients |
title_short |
Sex-specific prevalence and outcomes of frailty in critically ill patients |
title_full |
Sex-specific prevalence and outcomes of frailty in critically ill patients |
title_fullStr |
Sex-specific prevalence and outcomes of frailty in critically ill patients |
title_full_unstemmed |
Sex-specific prevalence and outcomes of frailty in critically ill patients |
title_sort |
sex-specific prevalence and outcomes of frailty in critically ill patients |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2020-09-01 |
description |
Abstract Background The prevalence of frailty, an important risk factor for short- and long-term outcomes in hospitalized adults, differs by sex. Studies in critically ill adults have also found differences in mortality and organ support rates in males and females. The objective of this study was to determine if these observed differences in mortality and organ support rates can be explained by sex and frailty alone, or if the interaction between sex and frailty is an important risk factor. Methods This is a retrospective multi-centre population-based cohort study of all adult patients (≥ 18 years) admitted to the seventeen intensive care units (ICUs) across Alberta, Canada, between 2016 and 2017. On admission, physicians assigned a Clinical Frailty Scale (CFS) score (1 = very fit, 9 = terminally ill) to all patients. Patients with missing CFS scores or who died within 24 h of ICU admission were excluded. Frailty was defined as CFS ≥ 5. Outcomes included all-cause hospital mortality, ICU mortality, and organ support rates. A propensity score for female sex was generated and 1:1 matching on sex was performed. Multivariable Cox regression or logistic regression, as appropriate, was performed to evaluate the association between sex, frailty, and the sex-frailty interaction term with outcomes. Results Of 15,238 patients included in the cohort, after propensity score matching 11,816 patients remained (mean [standard deviation] age 57.3 [16.9]). In the matched cohort, females had a higher prevalence of frailty than males (32% vs. 27%, respectively) and higher odds of frailty (odds ratio [95% confidence interval (CI)] 1.29 [1.20–1.40]). Though females were less likely to receive invasive mechanical ventilation (hazard ratio [95% CI] 0.78 [0.71–0.86]), the interaction between sex and frailty (i.e., males and females with and without frailty) was not associated with differences in organ support rates. Receipt of dialysis and vasoactive support, as well as hospital mortality and ICU mortality were associated with frailty but were not associated with female sex or the interaction between sex and frailty. Conclusions Although frailty and sex were individually associated with mortality and differences in organ support in the ICU, there does not appear to be a significant interaction between sex and frailty with regards to these outcomes. |
topic |
Frailty Sex Female Critical care Mortality Mechanical ventilation |
url |
http://link.springer.com/article/10.1186/s40560-020-00494-9 |
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