• An Zeng, Xiaowei Song, Jiahui Dong, Arnold Mitnitski, Jian Liu, Zhenhui Guo, and Kenneth Rockwood.
• School of Computers, Guangdong University of Technology, Guangzhou, China.
• J. Gerontol. A Biol. Sci. Med. Sci. 2015 Dec 1; 70 (12): 1586-94.

BackgroundIn older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival.MethodsOlder patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July-December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores.ResultsThe 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score-APACHE II and APACHE IV (r (2) = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%-15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days.ConclusionICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America.

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