Advanced echocardiographic phenotyping of critically ill patients with coronavirus-19 sepsis: a prospective cohort study

Abstract Background Sepsis is characterized by various hemodynamic alterations which could happen concomitantly in the heart, pulmonary and systemic circulations. A comprehensive demonstration of their interactions in the clinical setting of COVID-19 sepsis is lacking. This study aimed at evaluating the feasibility, clinical implications, and physiological coherence of the various indices of hemodynamic function and acute myocardial injury (AMI) in COVID-19 sepsis. Methods Hemodynamic and echocardiographic data of septic critically ill COVID-19 patients were prospectively recorded. A dozen hemodynamic indices exploring contractility and loading conditions were assessed. Several cardiac biomarkers were measured, and AMI was considered if serum concentration of high-sensitive troponin T (hs-TNT) was above the 99th percentile, upper reference. Results Sixty-seven patients were assessed (55 males), with a median age of 61 [50–70] years. Overall, the feasibility of echocardiographic parameters was very good, ranging from 93 to 100%. Hierarchical clustering method identified four coherent clusters involving cardiac preload, left ventricle (LV) contractility, LV afterload, and right ventricle (RV) function. LV contractility indices were not associated with preload indices, but some of them were positively correlated with RV function parameters and negatively correlated with a single LV afterload parameter. In most cases (n = 36, 54%), echocardiography results prompted therapeutic changes. Mortality was not influenced by the echocardiographic variables in multivariable analysis. Cardiac biomarkers’ concentrations were most often increased with high incidence of AMI reaching 72%. hs-TNT was associated with mortality and inversely correlated with most of LV and RV contractility indices. Conclusions In this comprehensive hemodynamic evaluation in critically ill COVID-19 septic patients, we identified four homogeneous and coherent clusters with a good feasibility. AMI was common and associated with alteration of LV and RV functions. Echocardiographic assessment had a clinical impact on patient management in most cases.

Download Full-text

Can Circulating Cardiac Biomarkers Be Helpful in the Assessment of LMNA Mutation Carriers?

Journal of Clinical Medicine ◽

10.3390/jcm9051443 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1443 ◽

Cited By ~ 2

Author(s):

Przemyslaw Chmielewski ◽

Ewa Michalak ◽

Ilona Kowalik ◽

Maria Franaszczyk ◽

Malgorzata Sobieszczanska-Malek ◽

...

Keyword(s):

Risk Assessment ◽

Clinical Laboratory ◽

Troponin T ◽

Multivariable Analysis ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Lamin A ◽

Lmna Mutation ◽

Mutation Carriers

Mutations in the lamin A/C gene are variably phenotypically expressed; however, it is unclear whether circulating cardiac biomarkers are helpful in the detection and risk assessment of cardiolaminopathies. We sought to assess (1) clinical characteristics including serum biomarkers: high sensitivity troponin T (hsTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in clinically stable cardiolaminopathy patients, and (2) outcome among pathogenic/likely pathogenic lamin A/C gene (LMNA) mutation carriers. Our single-centre cohort included 53 patients from 21 families. Clinical, laboratory, follow-up data were analysed. Median follow-up was 1522 days. The earliest abnormality, emerging in the second and third decades of life, was elevated hsTnT (in 12% and in 27% of patients, respectively), followed by the presence of atrioventricular block, heart failure, and malignant ventricular arrhythmia (MVA). In patients with missense vs. other mutations, we found no difference in MVA occurrence and, surprisingly, worse transplant-free survival. Increased levels of both hsTnT and NT-proBNP were strongly associated with MVA occurrence (HR > 13, p ≤ 0.02 in both) in univariable analysis. In multivariable analysis, NT-proBNP level > 150 pg/mL was the only independent indicator of MVA. We conclude that assessment of circulating cardiac biomarkers may help in the detection and risk assessment of cardiolaminopathies.

Download Full-text

Echocardiographic Assessment of Preload Responsiveness in Critically Ill Patients

Cardiology Research and Practice ◽

10.1155/2012/819696 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 43

Author(s):

Alexander Levitov ◽

Paul E. Marik

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Positive Pressure Ventilation ◽

Static Pressure ◽

Positive Pressure ◽

Fluid Loading ◽

Volume Responsiveness ◽

Preload Responsiveness ◽

Echocardiographic Parameters ◽

Echocardiographic Assessment

Fluid challenges are considered the cornerstone of resuscitation in critically ill patients. However, clinical studies have demonstrated that only about 50% of hemodynamically unstable patients are volume responsive. Furthermore, increasing evidence suggests that excess fluid resuscitation is associated with increased mortality. It therefore becomes vital to assess a patient's fluid responsiveness prior to embarking on fluid loading. Static pressure (CVP, PAOP) and echocardiographic (IVC diameter, LVEDA) parameters fails to predict volume responsiveness. However, a number of dynamic echocardiographic parameters which are based on changes in vena-caval dimensions or cardiac function induce by positive pressure ventilation or passive leg raising appear to be highly predictive of volume responsiveness.

Download Full-text

Titin-Related Dilated Cardiomyopathy: The Clinical Trajectory and the Role of Circulating Biomarkers in the Clinical Assessment

Diagnostics ◽

10.3390/diagnostics12010013 ◽

2021 ◽

Vol 12 (1) ◽

pp. 13

Author(s):

Przemysław Chmielewski ◽

Grażyna Truszkowska ◽

Ilona Kowalik ◽

Małgorzata Rydzanicz ◽

Ewa Michalak ◽

...

Keyword(s):

Heart Failure ◽

Risk Assessment ◽

Dilated Cardiomyopathy ◽

Troponin T ◽

Left Ventricular Systolic Dysfunction ◽

Multivariable Analysis ◽

Disease Onset ◽

Left Ventricular ◽

Cardiac Biomarkers

Titin truncating variants (TTNtv) are known as the leading cause of inherited dilated cardiomyopathy (DCM). Nevertheless, it is unclear whether circulating cardiac biomarkers are helpful in detection and risk assessment. We sought to assess 1) early indicators of cardiotitinopathy including the serum biomarkers high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in clinically stable patients, and 2) predictors of outcome among TTNtv carriers. Our single-center cohort consisted of 108 TTNtv carriers (including 70 DCM patients) from 43 families. Clinical, laboratory and follow-up data were analyzed. The earliest abnormality was left ventricular dysfunction, present in 8, 26 and 47% of patients in the second, third and fourth decade of life, respectively. It was followed by symptoms of heart failure, linked to NT-proBNP elevation and severe left ventricular systolic dysfunction, and later by arrhythmias. Hs-cTnT serum levels were increased in the late stage of the disease only. During the median follow-up of 5.2 years, both malignant ventricular arrhythmia (MVA) and end-stage heart failure (esHF) occurred in 12% of TTNtv carriers. In multivariable analysis, NT-proBNP level ≥650 pg/mL was the best predictor of both composite endpoints (MVA and esHF) and of MVA alone. In conclusion, echocardiographic abnormalities are the first detectable anomalies in the course of cardiotitinopathies. The assessment of circulating cardiac biomarkers is not useful in the detection of the disease onset but may be helpful in risk assessment.

Download Full-text

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study.

10.21203/rs.3.rs-31686/v2 ◽

2020 ◽

Author(s):

Reidun Aarsetøy ◽

Torbjørn Omland ◽

Helge Røsjø ◽

Heidi Strand ◽

Thomas Werner Lindner ◽

...

Keyword(s):

Cardiac Arrest ◽

Natriuretic Peptide ◽

Troponin T ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Sudden Cardiac Arrest ◽

Cardiac Biomarkers ◽

Prognostic Information ◽

Clinical Trial Registration ◽

Hospital Cardiac Arrest

Abstract Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the Southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors and significantly associated with time to death, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% CI 2.1 – 10.1), p < 0.001. This association was attenuated in the multivariable analysis [HR 2.18 (95% CI 0.83 – 5.72)], p = 0.11. NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.Conclusions: In OHCA, NT-proBNP was significantly associated with 30-day survival in univariate analysis, but associations were attenuated after multivariable adjustment. Hs-cTnT and copeptin did not provide prognostic information following OHCA.Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

Download Full-text

Titin-Related Dilated Cardiomyopathy: The Sequence of Events and The Role of Circulating Biomarkers in The Clinical Assessment

10.21203/rs.3.rs-692235/v1 ◽

2021 ◽

Author(s):

Przemysław Chmielewski ◽

Grażyna Truszkowska ◽

Ilona Kowalik ◽

Małgorzata Rydzanicz ◽

Ewa Michalak ◽

...

Keyword(s):

Heart Failure ◽

Risk Assessment ◽

Dilated Cardiomyopathy ◽

Troponin T ◽

Left Ventricular Systolic Dysfunction ◽

Multivariable Analysis ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Sequence Of Events

Abstract Titin truncating variants (TTNtv) are known as the leading cause of inherited dilated cardiomyopathy (DCM). Nevertheless, the clinical course is not fully understood and it is unclear whether circulating cardiac biomarkers are helpful in the detection and risk assessment. We sought to assess: 1) early signs of cardiotitinopathy including serum biomarkers: high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in clinically stable patients, and 2) indicators of outcome among TTNtv carriers. Our single-centre cohort included 108 carriers (including 70 DCM patients) from 43 families. Clinical, laboratory and follow-up data were analyzed. The earliest abnormality was left ventricular dysfunction, present in 8, 26 and 47% of patients in the 2nd, 3rd and 4th decade of life, respectively. It was followed by symptoms of heart failure and elevation of NT-proBNP, linked to severe (persistent or transient) left ventricular systolic dysfunction, and later by arrhythmias, preceding both malignant ventricular arrhythmia (MVA) and end-stage heart failure (esHF). Hs-cTnT serum levels were increased in the late stage of the disease only. During the median follow-up of 5.2 years both MVA and esHF occurred in 12% of TTNtv carriers. In multivariable analysis, NT-proBNP level ≥650 pg/ml was the best predictor of both composite endpoint (MVA and esHF), and of MVA alone. We conclude that assessment of circulating cardiac biomarkers is not useful in the detection of cardiotitinopathies but may be helpful in the risk assessment.

Download Full-text

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study.

10.21203/rs.3.rs-31686/v3 ◽

2020 ◽

Author(s):

Reidun Aarsetøy ◽

Torbjørn Omland ◽

Helge Røsjø ◽

Heidi Strand ◽

Thomas Werner Lindner ◽

...

Keyword(s):

Cardiac Arrest ◽

Natriuretic Peptide ◽

Troponin T ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Sudden Cardiac Arrest ◽

Cardiac Biomarkers ◽

Prognostic Information ◽

Clinical Trial Registration ◽

Hospital Cardiac Arrest

Abstract Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission.Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6 %) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors (p < 0.001) and significantly associated with 30-days all-cause mortality in univariate analysis, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% confidence interval (CI), 2.1 – 10.1), p < 0.001. This association was no longer significant in multivariable analysis applying continuous values, [HR 0.96, (95% CI, 0.64 - 1.43), p = 0.84]. Similar results were obtained by dividing the population by survival at hospital admission, excluding non-ROSC patients on-scene [HR 0.93 (95% CI, 0.50 - 1.73), P = 0.83]. We also noted that NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.Conclusions: Early-on levels of hs-cTnT, copeptin and NT-proBNP did not provide independent prognostic information following OHCA. Prediction was unaffected by excluding on-scene non-ROSC patients in the multivariable analysis. Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

Download Full-text

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study

10.21203/rs.3.rs-31686/v1 ◽

2020 ◽

Author(s):

Reidun Aarsetøy ◽

Torbjørn Omland ◽

Helge Røsjø ◽

Heidi Strand ◽

Thomas Werner Lindner ◽

...

Keyword(s):

Cardiac Arrest ◽

Natriuretic Peptide ◽

Troponin T ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Sudden Cardiac Arrest ◽

Cardiac Biomarkers ◽

Prognostic Information ◽

Clinical Trial Registration ◽

Hospital Cardiac Arrest

Abstract Background Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA). Methods We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. Results A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors and significantly associated with time to death, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% CI 2.1–10.1), p < 0.001. This association was attenuated in the multivariable analysis [HR 2.18 (95% CI 0.83–5.72)], p = 0.11. NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001. Conclusions In OHCA, NT-proBNP was significantly associated with 30-day survival in univariate analysis, but associations were attenuated after multivariable adjustment. Hs-cTnT and copeptin did not provide prognostic information following OHCA. Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

Download Full-text

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Current Diabetes Reviews ◽

10.2174/1573399814666180119142254 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-140 ◽

Cited By ~ 1

Author(s):

Ghada El Khoury ◽

Hanine Mansour ◽

Wissam K. Kabbara ◽

Nibal Chamoun ◽

Nadim Atallah ◽

...

Keyword(s):

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Center ◽

Descriptive Analysis ◽

Tertiary Care ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Download Full-text

265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa198 ◽

2020 ◽

Vol 22 (Supplement_N) ◽

pp. N65-N79

Author(s):

Luca Arcari ◽

Michelangelo Luciano ◽

Luca Cacciotti ◽

Maria Beatrice Musumeci ◽

Valerio Spuntarelli ◽

...

Keyword(s):

Hospital Mortality ◽

Natriuretic Peptides ◽

Multivariable Analysis ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Good Ability ◽

Myocardial Involvement ◽

D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p < 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p < 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p < 0.001 and AUC = 0.810, p < 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

Download Full-text

Frailty status among older critically ill patients with severe acute kidney injury

Critical Care ◽

10.1186/s13054-021-03510-y ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Alan Yang ◽

Gerald Lebovic ◽

Ron Wald ◽

Sean M. Bagshaw

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Multivariable Analysis ◽

Kidney Injury ◽

Multivariable Logistic Regression Analysis ◽

Clinical Frailty Scale ◽

Factors Associated ◽

Frailty Status ◽

Physiological Variables

Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

Download Full-text