Evaluation of the clinical frailty scale for predicting mortality or functional dependence at ICU discharge: A cohort study

Abstract

Abstract Frailty is a critical factor influencing outcomes in intensive care units (ICUs). A retrospective cohort study involving 8041 adult ICU patients in Curitiba (May 2023-April 2024) evaluated the role of the Clinical Frailty Scale (CFS) as a mortality risk and functional dependence at ICU discharge. Patients were classified according to their CFS score at admission, with higher scores indicating greater frailty. The primary outcomes were ICU mortality and transition to a higher level of functional dependence at discharge. Multivariable models were adjusted for age, sex, number of comorbidities, type of hospitalization, presence of limitations on life-sustaining therapies, and SOFA score within the first 24 h. The cohort had a mean age of 66 years (51.4% women), with a median SOFA score of 2. Most patients were classified as “managing well” (33.5%), “vulnerable” (21%), or “mildly frail” (10.1%). Overall ICU mortality was 11.5%, and more than 40% of patients were discharged with some degree of functional dependence. Higher frailty at admission was independently associated with worse outcomes, including increased mortality and greater functional dependence. These findings reinforce the value of frailty assessment by using the CFS to support prognostic decision-making in critically ill patients.