Frailty and one year survival in patients admitted to the intensive care unit following a medical emergency team review: a retrospective registry-based study.

Abstract

The association between frailty and long-term outcomes following intensive care unit (ICU) admission after a medical emergency team (MET) review is poorly understood. To evaluate whether frailty was associated with increased one-year mortality among ICU patients admitted after a ward MET review. Retrospective registry-based cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database. Adult patients (≥16 years) admitted to 184 ICUs between 1 January 2018 and 30 June 2022 with a documented Clinical Frailty Scale (CFS) score were included. None. Frailty was assessed categorically using the CFS 1-8. The primary outcome was one-year mortality, ascertained via linkage with respective national death registries. Associations between frailty and one-year mortality were evaluated using multivariable hierarchical logistic regression. A total of 48,425 patients were included. Patients with higher frailty scores were older, more likely to have treatment limitations and a greater chronic disease burden. The adjusted probability of one-year mortality increased progressively from 12.3% for CFS-1 to 60.8% for CFS-8. Compared with CFS-1, increased risk was observed beyond CFS-3, with the adjusted attributable mortality risk ranging from +5.6% (95%CI: 2.8-8.4%) for CFS-2 to +48.5% (95%CI: 43.6-53.4%) for CFS-8. In this large cohort of ICU patients admitted after a MET review, frailty was independently associated with higher one-year mortality, with outcomes worsening progressively with incrementing CFS. Our findings highlight the importance of incorporating frailty assessment into MET and ICU decision-making to guide individualised, goal-concordant care.