Table 2. Selected studies on instruments for frailty screening that are relevant for German intensive care units*.
| Instrument(s) | Study | Number/age of patients | Design |
Diagnostic accuracy [95% CI] |
Conclusion |
| CFS FP |
Le Maguet et al. (25) |
196/≥ 65 | Multicenter prospective observational study(intensive care patients) | Significant correlation between CFS and FP (R2 = 0.66, p <0.001) Multivariate analysis ICU survival: FP score ≥ 3 (HR: 3.3; [1.6; 6.6]; p <0.001) Six-month mortality: CFS ≥ 5 (HR: 2.4; [1.49; 3.87]; p <0.001) |
The CFS is not inferior to FP, but is much easier to ascertain. |
| CFS | De Geer et al. (27) |
872/≥ 18 | Single-center prospective observational study(intensive care patients) | Thirty-day survival: CFS AUC: 0.74; [0.69; 0.79] versus SAPS 3 (0.79; [0.75; 0.83]; p = 0.53) Thirty-day mortality: CFS adjusted for SAPS 3 (HR: 2,12; [1.44; 3.14]; p <0.001) |
The CFS offers additional prognostic benefit in intensive care patients. |
| CFS | Flaatten et al. (VIP-1) (34) |
5 021/≥ 80 | Multicenter prospective observational study(intensive care patients) | Dichotomized CFS ≥ 5 = independently elevated risk of 30-day mortality (HR: 1.54; [1.38; 1.73] |
Frailty according to the CFS is an independent risk factor in intensive care patients. |
| CFS | Guidet et al. (VIP-2) (4) | 3 920/≥ 80 | Multicenter prospective observational study(intensive care patients) | Multivariable analysis showed the ordinally scaled CFS to be a risk factor for 1-month mortality (HR: per point CFS 1.1; [1.05; 1.15]; p <0.001) | Frailty according to the CFS is an independent risk factor in intensive care patients. |
| HFRS | Bruno et al. (21) | 1 498/≥ 75 | Single-center retrospective observational study(intensive care patients) | No independent association of HFRS with ICU mortality after adjustment of multivariable model for APACHE II (HR: 1.03; [0.98; 1.09]; p = 0.27) SAPS II (HR 1.05; [0.99; 1.11]; p = 0.14) |
The HFRS yields no additional benefit in German intensive care patients. |
| FP | Ferrante et al. (5) | 391/≥ 70 | Single-center prospective observational study(intensive care patients) | Frailty according to FP: 41% higher rate of disability at 6 months after ICU (adjusted risk ratio: 1.41; [1.12; 1.78]) (OR: 3.52; [1.23; 10.08]) and higher risk of admission to a care home Six-month mortality: doubling with each FP point (HR: 2.00; [1.33; 3.00] |
FP helps to assess the long-term care needs. |
*To determine whether the instruments examined in the studies are suitable for use in German intensive care units, the studies were analyzed with regard to the following questions: Were intensive care patients investigated? Were a sufficient number of patients analyzed? Did the validation take place in German/European intensive care units? Was the intended age group investigated? Do the results justify the conclusion that the instrument is suitable?
APACHE II, Acute Physiology and Chronic Health Score II; AUC, area under the curve; aOR, adjusted odds ratio; CFS, Clinical Frailty Scale; CHS, Cardiovascular Health Study Scale; eFI, electronic frailty index; FRAIL, FRAIL scale; FP, Fried’s phenotype; FI, frailty index; HR, hazard ratio; HFRS, Hospital Frailty Risk Score; mFI, modified frailty index; OR, odds ratio; SAPS II/3, Simplified Acute Physiology Score II/3; SOFA, Sequential Organ Failure Assessment Score; SOF, Study of Osteoporotic Fractures scale; ROC, receiver operating characteristic; 95% CI, 95% confidence interval