TOPLINE

Patients who were frail or dependent on others before admission had an increased risk for all-cause mortality after admission to the ICU, although the overall evidence remained uncertain and highly variable across studies.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis to assess whether the functional status before admission was associated with mortality and other outcomes among patients admitted to the ICU.
• They searched multiple databases through June 2025 and included 55 prospective cohort studies. Of them, 21 studies contributed to the meta-analysis.
• Study sizes ranged from 25 to 8907 patients; 31 studies included patients aged 50 years or older. The longest duration of follow-up was 1 year.
• Researchers used relevant scales to assess whether patients were frail and scores of activities of daily living to assess whether they were dependent on others.
• The primary outcome was mortality at the longest reported follow‑up. Exploratory outcomes included the length of stay in the hospital, the need for renal replacement therapy, and quality of life.

TAKEAWAY

• Patients who were not frail before admission had a 38% lower risk for mortality than those who were frail before admission (P < .01). The finding came from a pooled analysis of five studies with a low risk for bias, and the certainty of evidence was very low.
• Patients who were independent before admission had a 53% lower risk for mortality than those who were dependent on others before admission (P < .01). The finding came from five studies with a moderate or high risk for bias, and the certainty of evidence was very low.
• Most exploratory outcomes did not have a clear association with frailty. Patients without frailty were more likely to be discharged home than those with frailty, although this finding came from only two studies (P = .02).
• Heterogeneity across studies was substantial.

IN PRACTICE

"[The] results may inform further research on targeted treatment and rehabilitation strategies and, furthermore, illustrate the need to apply future core outcome sets to assess functional status," the researchers reported.

SOURCE

The study was led by Lone M. Poulsen, MD, of Zealand University Hospital in Køge, Denmark. It was published online on August 28 in the British Journal of Anaesthesia.

LIMITATIONS

Researchers excluded retrospective studies, which may have limited the generalizability of findings. They could not account for key confounders or assess differences between subgroups. The primary analyses were restricted to studies with low risk for bias.

DISCLOSURES

No specific funding source was reported for the study. One author reported receiving funding from the Novo Nordisk Foundation. Three authors were affiliated with departments that received funding from various sources. Detailed author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.