Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the Deli study

Authors

Steven A. Frost, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Kathleen Brennan, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
David Sanchez, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Joan Lynch, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Sonja Hedges, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Yu Chin Hou, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Masar El Sayfe, Fairfield Hospital Prairiewood
Sharon Ann Shunker, Liverpool Hospital
Tony Bogdanovski, Liverpool Hospital
Leanne Hunt, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Evan Alexandrou, Critical Care Research in Collaboration and Evidence Translation (CCRiCET)
Kaye Rolls, Faculty of Science, Medicine and Health
Danielle Ni Chroinin, Liverpool Hospital
Anders Aneman, Liverpool Hospital

Publication Name

Acta Anaesthesiologica Scandinavica

Abstract

Background: Delirium is an acute disorder of attention and cognition with an incidence of up to 70% in the adult intensive care setting. Due to the association with significantly increased morbidity and mortality, it is important to identify who is at the greatest risk of an acute episode of delirium while being cared for in the intensive care. The objective of this study was to determine the ability of the cumulative deficit frailty index and clinical frailty scale to predict an acute episode of delirium among adults admitted to the intensive care. Methods: This study is a secondary analysis of the Deli intervention study, a hybrid stepped-wedge cluster randomized controlled trial to assess the effectiveness of a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adult intensive care units in the south-west of Sydney, Australia. Important predictors of delirium were identified using a bootstrap approach and the absolute risks, based on the cumulative deficit frailty index and the clinical frailty scale are presented. Results: During the 10-mth data collection period (May 2019 and February 2020) 2566 patients were included in the study. Both the cumulative deficit frailty index and the clinical frailty scale on admission, plus age, sex, and APACHE III (AP III) score were able to discriminate between patients who did and did not experience an acute episode of delirium while in the intensive care, with AUC of 0.701 and 0.703 (moderate discriminatory ability), respectively. The addition of a frailty index to a prediction model based on age, sex, and APACHE III score, resulted in net reclassified of risk. Nomograms to individualize the absolute risk of delirium using these predictors are also presented. Conclusion: We have been able to show that both the cumulative deficits frailty index and clinical frailty scale predict an acute episode of delirium among adults admitted to intensive care.

Open Access Status

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