• Aluko A Hope, Jammie Law, Rahul Nair, Mimi Kim, Joe Verghese, and GongMichelle NgMNDepartment of Medicine, Division of Critical Care Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Department of Epidemiology and Population Health, 2006Albert Einstein College of Medicine, B.
• Department of Medicine, Division of Critical Care Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
• J Intensive Care Med. 2020 Dec 1; 35 (12): 1505-1512.

PurposeWe aimed to describe the association between prehospital frailty (PHF), acute organ dysfunction (AOD), and posthospital disability (PHD) outcome in older adults admitted to the intensive care unit (ICU).MethodsIn a prospective observational cohort study, we assessed PHF using the Clinical Frailty Scale (CFS) and assessed the level of AOD using Sequential Organ Failure Assessment (SOFA) scores on ICU day 1. We assessed Activities of Daily Living disability levels through to 6 months after discharge and used generalized estimating equations (log link and negative binomial family) to determine the independent association of PHF and AOD with PHD.ResultsOf the 302 patients enrolled, 221 (73.1%) survived the hospitalization. Prehospital frailty was associated with PHD (adjusted incident rate ratio [aIRR] 95% confidence interval [95% CI] per unit increase in CFS 1.38 [1.15-1.67], P = .001). Total day 1 SOFA score was weakly associated with PHD, (aIRR [95% CI] 1.05 [1.00-1.10], P = .037) while day 1 SOFA neurologic score was strongly associated with PHD (aIRR [95% CI] 1.42 [1.24-1.62] per unit increase in SOFA neurologic score, P < .001), and these effects were independent of PHF and other premorbid factors.ConclusionsBoth PHF and early acute brain dysfunction are important factors associated with increasing PHD in older adults who survive critical illness.

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