The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis
Open accessAbstract
Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials.gov. All study designs with the exception of narrative reviews, case reports, and editorials were included. Included studies assessed frailty in patients greater than 18 years of age admitted to an ICU and compared outcomes between fit and frail patients. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were hospital and long-term mortality. We also determined the prevalence of frailty, the impact on other patient-centered outcomes such as discharge disposition, and health service utilization such as length of stay. Ten observational studies enrolling a total of 3030 patients (927 frail and 2103 fit patients) were included. The overall quality of studies was moderate. Frailty was associated with higher hospital mortality [relative risk (RR) 1.71; 95% CI 1.43, 2.05; p < 0.00001; I 2 = 32%] and long-term mortality (RR 1.53; 95% CI 1.40, 1.68; p < 0.00001; I 2 = 0%). The pooled prevalence of frailty was 30% (95% CI 29–32%). Frail patients were less likely to be discharged home than fit patients (RR 0.59; 95% CI 0.49, 0.71; p < 0.00001; I 2 = 12%). Frailty is common in patients admitted to ICU and is associated with worsened outcomes. Identification of this previously unrecognized and vulnerable ICU population should act as the impetus for investigating and implementing appropriate care plans for critically ill frail patients. Registration: PROSPERO (ID: CRD42016053910).
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The use of thickening food to increase oral intake has not been validated in the ICU.
“However, this approach has not been validated in the ICU (312).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [312]
The Discussion’s implications section (page unavailable) mentions nutritional support only as a possible ICU process of care to study. Searches for thickened food, oral intake, dysphagia, and ICU validation found no passage addressing whether thickening food to increase oral intake has been validated in the ICU. (LLM, conf=0.76)
Experimental — accuracy not yet measured29% of 446 ICU patients had prolonged post-extubation swallowing disorder at discharge, and some post-extubation swallowing disorder has been shown 4 months after discharge.
“Recently, 29% of 446 ICU patients had prolonged post-extubation swallowing disorder at discharge and some postextubation swallowing disorder has been shown 4 months after discharge (312).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [312]
The Results sections on mechanical ventilation and discharge disposition address frailty outcomes, not swallowing after extubation. Searches for swallowing disorder, dysphagia, 446 patients, and four-month follow-up found no passage supporting either part of the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFrailty is a reliable predictor of clinical and healthcare-related outcomes in intensive care unit and acute hospital settings.
“The effect of frailty on patient’s clinical outcomes has been examined in several settings of care, including intensive care units (ICU) and acute hospital wards [1, 2], showing to be a reliable predictor of clinical and health care related outcomes.”
From Frailty index predicts poor outcome in COVID-19 patients (2020) · cites this paper as [2]
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Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013) · The Lancet · doi:10.1016/s0140-6736(12)62167-9 · Cited by 9,503 · see citing works
Self-citationEstimating the mean and variance from the median, range, and the size of a sample
Hozo, S. P., Djulbegovic, B., & Hozo, I. (2005) · BMC Medical Research Methodology · doi:10.1186/1471-2288-5-13 · Cited by 9,062 · see citing works
A global clinical measure of fitness and frailty in elderly people
Rockwood, K. (2005) · Canadian Medical Association Journal · doi:10.1503/cmaj.050051 · Cited by 8,968 · see citing works
Self-citationFried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/59.3.m255 · Cited by 4,032 · see citing works
Accumulation of Deficits as a Proxy Measure of Aging
Mitnitski, A. B., Mogilner, A. J., & Rockwood, K. (2001) · The Scientific World JOURNAL · doi:10.1100/tsw.2001.58 · Cited by 2,893 · cited 1× · see citing works
“Frailty was assessed using the clinical frailty scale (CFS) [3] in seven studies, a frailty index (FI) [38] in four, and the frailty physical phenotype (FP) [39] in two (Table 3).”
MethodSelf-citationThe Frailty Syndrome: Definition and Natural History
Xue, Q. (2010) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2010.08.009 · Cited by 2,067 · see citing works
Inflammation and frailty in the elderly: A systematic review and meta-analysis
Soysal, P., Stubbs, B., Lucato, P., Luchini, C., Solmi, M., Peluso, R., Sergi, G., Isik, A. T., Manzato, E., Maggi, S., et al. (2016) · Ageing Research Reviews · doi:10.1016/j.arr.2016.08.006 · Cited by 1,089 · see citing works
Outcome instruments to measure frailty: a systematic review
de Vries, N. M., Staal, J. B., van Ravensberg, C. D., Hobbelen, J. S. M., Olde Rikkert, M. G. M., & Nijhuis-van der Sanden, M. W. G. (2011) · Ageing Research Reviews · doi:10.1016/j.arr.2010.09.001 · Cited by 793 · see citing works
Lee, D. H., Buth, K. J., Martin, B., Yip, A. M., & Hirsch, G. M. (2010) · Circulation · doi:10.1161/circulationaha.108.841437 · Cited by 677 · see citing works
Turner, G., & Clegg, A. P. (2014) · Age and Ageing · doi:10.1093/ageing/afu138 · Cited by 677 · see citing works
Bagshaw, S. M., Stelfox, H. T., McDermid, R. C., Rolfson, D. B., Tsuyuki, R. T., Baig, N., Bobranska-Artiuch, B., Ibrahim, Q. I., Stollery, D. E., Rokosh, E., et al. (2013) · Canadian Medical Association Journal · doi:10.1503/cmaj.130639 · Cited by 551 · see citing works
Self-citationRedefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-Morbidity
Robinson, T. N., Eiseman, B., Wallace, J. I., Church, S. D., McFann, K. K., Pfister, S. M., Sharp, T. J., & Moss, M. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e3181b45598 · Cited by 543 · see citing works
Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients
Joseph, B. A., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O’Keeffe, T., Tang, A. L., Vercruysse, G. A., Fain, M. J., et al. (2014) · JAMA Surgery · doi:10.1001/jamasurg.2014.296 · Cited by 500 · see citing works
Frailty is associated with postoperative complications in older adults with medical problems
Dasgupta, M., Rolfson, D. B., Stolee, P., BORRIE, M. J., & Speechley, M. R. (2008) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2007.10.007 · Cited by 462 · see citing works
Rostoft, S., Nesbakken, A., Slaaen, M., Skovlund, E., Audisio, R. A., Johannessen, H., Bakka, A. O., & Wyller, T. B. (2009) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2009.11.002 · Cited by 456 · see citing works
Frailty and Subsequent Disability and Mortality among Patients with Critical Illness
Brummel, N. E., Bell, S. P., Girard, T. D., Pandharipande, P. P., Jackson, J. C., Morandi, A., Thompson, J. L., Chandrasekhar, R., Bernard, G. R., Dittus, R. S., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201605-0939oc · Cited by 332 · see citing works
Maguet, P. L., Roquilly, A., Lasocki, S., Asehnoune, K., Carise, E., Martin, M. S., Mimoz, O., Gac, G. L., Somme, D., Cattenoz, C., et al. (2014) · Intensive Care Medicine · doi:10.1007/s00134-014-3253-4 · Cited by 298 · see citing works
Frailty is associated with the epigenetic clock but not with telomere length in a German cohort
Breitling, L. P., Saum, K.-U., Perna, L., Schöttker, B., Holleczek, B., & Brenner, H. (2016) · Clinical Epigenetics · doi:10.1186/s13148-016-0186-5 · Cited by 296 · see citing works
Heyland, D. K., Garland, A., Bagshaw, S. M., Cook, D., Rockwood, K. J., Stelfox, H. T., Dodek, P., Fowler, R., Turgeon, A. F., Burns, K. E. A., et al. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-4028-2 · Cited by 253 · see citing works
Self-citationValidation of an index to estimate the prevalence of frailty among community-dwelling seniors.
Hoover, M., Rotermann, M., Sanmartin, C., & Bernier, J. (2013) · PubMed · Cited by 251 · see citing works
How should we grade frailty in nursing home patients?
Rockwood, K., Abeysundera, M. J., & Mitnitski, A. (2007) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2007.07.012 · Cited by 249 · see citing works
Self-citationThe challenge of admitting the very elderly to intensive care
Nguyen, Y.-L., Angus, D. C., Boumendil, A., & Guidet, B. (2011) · Annals of Intensive Care · doi:10.1186/2110-5820-1-29 · Cited by 235 · see citing works
Disability and co-morbidity in relation to frailty: How much do they overlap?
Theou, O., Rockwood, M. R. H., Mitnitski, A., & Rockwood, K. J. (2012) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2012.03.001 · Cited by 232 · see citing works
Self-citationFrailty in the critically ill: a novel concept
McDermid, R. C., Stelfox, H. T., & Bagshaw, S. M. (2011) · Critical Care · doi:10.1186/cc9297 · Cited by 221 · see citing works
Self-citationMueller, N., Murthy, S., Tainter, C. “., Lee, J., Riddell, K., Fintelmann, F. J., Grabitz, S. D., Timm, F. P., Levi, B., Kurth, T., et al. (2015) · Annals of Surgery · doi:10.1097/sla.0000000000001546 · Cited by 204 · see citing works
The rate of aging: the rate of deficit accumulation does not change over the adult life span
Mitnitski, A., & Rockwood, K. J. (2015) · Biogerontology · doi:10.1007/s10522-015-9583-y · Cited by 143 · see citing works
Self-citationHogan, D. B., Maxwell, C. J., Afilalo, J., Arora, R. C., Bagshaw, S. M., Basran, J., Bergman, H., Bronskill, S. E., Carter, C., Dixon, E., et al. (2017) · Canadian Geriatrics Journal · doi:10.5770/cgj.20.240 · Cited by 129 · see citing works
Self-citationAging, frailty and complex networks
Mitnitski, A., Rutenberg, A. D., Farrell, S. R. M., & Rockwood, K. J. (2017) · Biogerontology · doi:10.1007/s10522-017-9684-x · Cited by 129 · see citing works
Self-citationScreening for frailty in Canada’s health care system: A time for action
Muscedere, J., Andrew, M. K., Bagshaw, S. M., Estabrooks, C., Hogan, D., Holroyd-Leduc, J., Howlett, S., Lahey, W., Maxwell, C., McNally, M., et al. (2016) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980816000301 · Cited by 112 · see citing works
Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit
Zeng, A., Song, X., Dong, J., Mitnitski, A., Liu, J., Guo, Z., & Rockwood, K. (2015) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glv084 · Cited by 96 · see citing works
Self-citationFrailty Before Critical Illness and Mortality for Elderly Medicare Beneficiaries
Hope, A. A., Gong, M. N., Guerra, C., & Wunsch, H. (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13436 · Cited by 84 · see citing works
Viña, J., Tarazona‐Santabalbina, F. J., Pérez‐Ros, P., Martínez‐Arnau, F. M., Borrás, C., González, G. O., Salvador‐Pascual, A., & Gómez‐Cabrera, M. C. (2016) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2016.04.005 · Cited by 75 · see citing works
Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery
Rajabali, N., Rolfson, D. B., & Bagshaw, S. M. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.05.011 · Cited by 71 · see citing works
Self-citationAssessing the Usefulness and Validity of Frailty Markers in Critically Ill Adults
Hope, A. A., Hsieh, S.-J. J., Petti, A., et al. (2017) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201607-538oc · Cited by 70 · see citing works
Development of a Frailty Index for Patients with Coronary Artery Disease
Freiheit, E., Hogan, D. B., Eliasziw, M., Meekes, M. F., Ghali, W. A., Partlo, L. A., & Maxwell, C. J. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02961.x · Cited by 67 · see citing works
Fisher, C., Karalapillai, D. K., Bailey, M., Glassford, N. J., Bellomo, R., & Jones, D. (2015) · Anaesthesia and Intensive Care · doi:10.1177/0310057x1504300313 · Cited by 61 · see citing works
Network model of human aging: Frailty limits and information measures
Farrell, S. G., Mitnitski, A., Rockwood, K. J., & Rutenberg, A. D. (2016) · Physical review. E · doi:10.1103/physreve.94.052409 · Cited by 48 · see citing works
Self-citationTu, K.-Y., Wu, M., Chen, Y., Lin, P., Wang, H., Wu, C.-K., & Tseng, P. (2016) · Medicine · doi:10.1097/md.0000000000002411 · Cited by 46 · see citing works
Is frailty a prognostic factor for critically ill elderly patients?
Kızılarslanoğlu, M. C., Civelek, R., Kılıç, M. K., et al. (2016) · Aging Clinical and Experimental Research · doi:10.1007/s40520-016-0557-y · Cited by 41 · see citing works
Dynamical network model for age-related health deficits and mortality
Taneja, S., Mitnitski, A., Rockwood, K. J., & Rutenberg, A. D. (2016) · Physical review. E · doi:10.1103/physreve.93.022309 · Cited by 38 · see citing works
Self-citationFrailty: Scaling from Cellular Deficit Accumulation?
Rockwood, K. J., Mitnitski, A., & Howlett, S. E. (2015) · Interdisciplinary topics in gerontology and geriatrics · doi:10.1159/000381127 · Cited by 18 · see citing works
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Research works printed but not linked: 6
- [20]Waters BVA, Bagshaw S, Boyd J, Maslove D, Sibley S, Rockwood E, Muscedere J (2017) The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med Exp, September abstract supplementary issue (in press) PMC5501903 28676896
- [22]Waters B, Varambally A, Muscedere J (2017) The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016053910. Accessed 1 June 2017 PMC5501903 28676896
- [30]Hope AAHS Petti A Hurtado-Sbordoni M Gong MN Bedside frailty assessment and hospital outcomes in critically ill patients J Am Geriatr Soc 2015 63 S180 10.1111/jgs.13436 · DOI
- [36]Heyland D Cook D Bagshaw SM Garland A Stelfox HT Mehta S Dodek P Kutsogiannis J Burns K Muscedere J Turgeon AF Fowler R Jiang X Day AG Canadian Critical Care Trials Group Canadian Researchers at the End of Life Network The very elderly admitted to ICU: a quality finish? Crit Care Med 2015 43 1352 1360 10.1097/CCM.0000000000001024 25901550 · DOI
- [39]Fried LP Tangen CM Walston J Newman AB Hirsch C Gottdiener J Seeman T Tracy R Kop WJ Burke G McBurnie MA Cardiovascular Health Study Collaborative Research Group Frailty in older adults: evidence for a phenotype J Gerontol A Biol Sci Med Sci 2001 56 146 156 10.1093/gerona/56.3.M146 11253156 · DOI · Paper page
- [40]Bagshaw SM Stelfox HT Johnson JA McDermid RC Rolfson DB Tsuyuki RT Ibrahim Q Majumdar SR Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study Crit Care Med 2015 43 973 982 10.1097/CCM.0000000000000860 25668751 · DOI
Cited by
Sorted by citations
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
Frailty index predicts poor outcome in COVID-19 patients
COVID-19 Monza Team members, Bellelli, G., Rebora, P., Valsecchi, M. G., Bonfanti, P., & Citerio, G. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-06087-2 · Cited by 114 · see citing works
<scp>COVID</scp> ‐19: Use of the Clinical Frailty Scale for Critical Care Decisions
Chong, E., Chan, M., Tan, H. N., & Lim, W. S. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16528 · Cited by 50 · see citing works
- Authors
- Muscedere, J., Waters, B., Varambally, A., Bagshaw, S. M., Boyd, J. G., Maslove, D., Sibley, S., & Rockwood, K.
- Affiliations
- Queen's University (CA)
- McMaster University (CA)
- Midwestern University (US)
- University of Alberta (CA)
- Dalhousie University (CA)
- Corresponding author
- Muscedere, John
- Venue
- Intensive Care Medicine
- Published
- 2017-07-04
- Volume
- 43
- Issue
- 8
- Pages
- 1105-1122
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- PMC
- PMC5501903
- OpenAlex
- W2728404809
- Cited by
- 827
- References
- 44
- Citations by year
- 2026: 74 · 2025: 87 · 2024: 97 · 2023: 82 · 2022: 112 · 2021: 128 · 2020: 121 · 2019: 72 · 2018: 44 · 2017: 9
- FWCI
- 7.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Intensive Care Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Sanofi
- Dalhousie Medical Research Foundation
- Consortium canadien en neurodégénérescence associée au vieillissement
- Government of Canada
- Alzheimer Society
- Nova Scotia Health Research Foundation
- Dalhousie University
- H. Lundbeck A/S
- Canadian Frailty Network
- Pfizer Canada
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- frailty, intensive care unit admission, critically ill patients, in-hospital mortality, long-term mortality, frailty prevalence, discharge disposition, length of hospital stay, prognostic factors, functional status
- MeSH terms
- Frailty, Adult, Age Factors, Humans, Intensive Care Units, Length of Stay, Prospective Studies, Risk Factors, Severity of Illness Index, Prevalence, Critical Illness, Treatment Outcome, Hospital Mortality, Observational Studies as Topic
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