Enhancing Delirium Prediction in ICU Older Patients Through the 5-Factor Modified Frailty Index
Hongtao Cheng
School of Nursing, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorYonglan Tang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorTanjian Li
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorYuting Huang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorXin Liang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorLei Wang
Department of Intensive Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
Search for more papers by this authorCorresponding Author
Jun Lyu
Clinical Research Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
Correspondence:
Jun Lyu ([email protected])
Yu Wang ([email protected])
Search for more papers by this authorCorresponding Author
Yu Wang
School of Nursing, Jinan University, Guangzhou, China
Community Health Service Center of Jinan University, Guangzhou, China
Department of School Clinic, The First Affiliated Hospital of Jinan University, Guangzhou, China
Correspondence:
Jun Lyu ([email protected])
Yu Wang ([email protected])
Search for more papers by this authorHongtao Cheng
School of Nursing, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorYonglan Tang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorTanjian Li
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorYuting Huang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorXin Liang
School of Nursing, Jinan University, Guangzhou, China
Search for more papers by this authorLei Wang
Department of Intensive Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
Search for more papers by this authorCorresponding Author
Jun Lyu
Clinical Research Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
Correspondence:
Jun Lyu ([email protected])
Yu Wang ([email protected])
Search for more papers by this authorCorresponding Author
Yu Wang
School of Nursing, Jinan University, Guangzhou, China
Community Health Service Center of Jinan University, Guangzhou, China
Department of School Clinic, The First Affiliated Hospital of Jinan University, Guangzhou, China
Correspondence:
Jun Lyu ([email protected])
Yu Wang ([email protected])
Search for more papers by this authorFunding: The authors received no specific funding for this work.
Xinya Li and Hongtao Cheng contributed equally to this study.
ABSTRACT
Background
Delirium and frailty are prevalent in the ICU, yet there is a paucity of research utilising frailty as determined by the 5-factor modified frailty index (mFI-5) to examine its correlation with delirium in intensive care unit (ICU) older patients.
Aim
The aim of this research was to explore the association between the mFI-5 and the occurrence of delirium in older patients admitted to the ICU, while assessing the mFI-5's predictive value for delirium.
Study Design
This study employed data extracted from the Medical Information Mart for Intensive Care IV database. The participants were classified into three groups based on their mFI-5 scores: non-frail (mFI-5 = 0), intermediate frailty (mFI-5 = 1) and high frailty (mFI-5 ≥ 2). The predictive value of mFI-5 for delirium was evaluated using the area under the curve, the net reclassification improvement and the integrated discrimination improvement metrics.
Results
Delirium was observed in 9919 of the 30 280 patients included in the study. Patients with intermediate frailty (adjusted odds ratios [OR]: 1.38, 95% CI: 1.28–1.48, p < 0.001) and high frailty (adjusted OR: 1.83, 95% CI: 1.69–1.97, p < 0.001) exhibited a markedly elevated risk of delirium in comparison to non-frail patients. Furthermore, the incorporation of the mFI-5 into the multivariate model markedly enhanced its predictive accuracy for delirium.
Conclusions
Frailty as assessed by the mFI-5 is strongly correlated with an elevated risk of delirium in older ICU patients. The incorporation of the mFI-5 into delirium prediction models may enhance the predictive accuracy of these models.
Relevance to Clinical Practice
The mFI-5 is a valuable tool for identifying older ICU patients at higher risk of delirium, aiding in early intervention and tailored care.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data were available on the MIMIC-IV website at https://mimic.physionet.org/. The data in this article can be reasonably applied to the corresponding author.
Supporting Information
| Filename | Description |
|---|---|
| nicc70098-sup-0001-supinfo.docxWord 2007 document , 1.6 MB |
Table S1. 5-factor modified frailty index. Table S2. Baseline characteristics of populations grouped by 5-factor modified frailty index. Table S3. Logistic regression: Association between frailty and delirium as assessed by the 5-factor modified frailty index (mFI-5 as a continuous variable). Figure S1. Comparison of receiver operating characteristic curves for the four models (with 5-factor modified frailty index). Figure S2. Kaplan–Meier survival curves between groups. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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