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Frailty, the decline in physical and cognitive reserves leading to vulnerability to stressors is increasingly being recognized as a public health concern. Although multiple measures exist that can identify frail patients, very little is known about how or when to intervene. Sarcopenia, or the degree of muscle wasting, is closely correlated to frailty and patient outcomes. This is a prospective cohort study of critically ill patients to identify modifiable risk factors of sarcopenia, as potential targets to reduce frailty.
Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. Frailty is not a disease, but a syndrome with a distinct frail phenotype that includes decreased status in mobility, muscle mass, nutritional status, strength, and endurance. Frail patients are at greater risk of adverse outcomes, such as functional decline, prolonged hospitalization with associated increases in healthcare costs and death. Multiple measures of frailty exist and although they are important for understanding risk for a given patient population or resource utilization, they do not provide any insight as to how to manage or treat frail patients.
In critically ill patients, sarcopenia has long been tied to poor outcomes, poor nutrition status, and decreased ability to perform activities of daily living (ADLs). We hypothesize that sarcopenia as a marker for frailty in critically ill patients can be used to track development and recovery of frailty.
The objective of this proposal to create a prospective cohort study of critically ill patients to identify modifiable risk factors of sarcopenia as potential targets for therapeutic measures to improve or reverse frailty.
The primary aim of the study is to track sarcopenia in critically ill patients. Sarcopenia is a measure of frailty and is associated with worse outcomes in critically ill patients. The aim to understand how the kinetics of sarcopenia differ in critically ill population given the heterogeneity of with various disease process which may affect the degree and rate of muscle wasting. Understanding the disease process is important in identifying when or how to intervene to obtain meaningful recovery.
Secondary aims are to assess the role biomarkers in patients across the frailty spectrum to understand their role frailty. Additionally nutrition is well known to affect sarcopenia and nutritional status is a key component in frailty. Nutrition status will be tracked to understand development of sarcopenia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ICU Patients | Adult Surgical, Cardiothoracic, and Neuro- ICU patients will be enrolled within 48 hrs of admission |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound | Diagnostic Test | 2D ultrasound image collection |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Discharge Disposition | Disposition of patient at time of hospital discharge, home, rehabilitation or skilled nursing facility, in hospital death | Patients will be followed from enrollment to hospital discharge. Approximately 2 weeks to 2 months |
| Length of ICU stay | Length of time patient is admitted to ICU until transfer out of the ICU | Patients will be followed from enrollment to ICU transfer. Approximately 2 weeks to 2 months |
| Length of Hospital stay | Length of time patient is admitted to the hospital including length of time patient spends in the ICU until discharge or death | Patients will be followed from enrollment until discharge from the hospital. Approximately 2 weeks to 2 months |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse Events | Falls, fractures, number of emergency room visits, number of times hospitalized, total hospital days and mortality | Patients will be followed from enrollment to 1 year. |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients admitted to the the Surgical, Cardiothoracic, or Neuro ICU.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jennifer Scovotti, MA | Contact | 3102064484 | jscovotti@mednet.ucla.edu |
| Name | Affiliation | Role |
|---|---|---|
| Cecilia Canales, MD, MPH | UCLA Department of Anesthesiology and Perioperative Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ronald Reagan UCLA Medical Center, Department of Anesthesiology & Perioperative Medicine | Recruiting | Los Angeles | California | 90095 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31609228 | Background | Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019 Oct 12;394(10206):1365-1375. doi: 10.1016/S0140-6736(19)31786-6. | |
| 21093718 | Background | Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011 Feb;27(1):1-15. doi: 10.1016/j.cger.2010.08.009. |
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The data will not be shared outside the study team.
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| ID | Term |
|---|---|
| D000073496 | Frailty |
| D055948 | Sarcopenia |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009133 | Muscular Atrophy |
| D020879 | Neuromuscular Manifestations |
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| ID | Term |
|---|---|
| D014463 | Ultrasonography |
| D011795 | Surveys and Questionnaires |
| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D003625 | Data Collection |
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| Biomarker Analysis |
| Diagnostic Test |
Inflammatory and nutritional biomarker analysis |
|
| Frailty Index | Other | A Frailty Index Questionnaire be completed by patients or their surrogates to determine the presence of frailty at ICU admission |
|
|
| 26155837 | Background | Op het Veld LP, van Rossum E, Kempen GI, de Vet HC, Hajema K, Beurskens AJ. Fried phenotype of frailty: cross-sectional comparison of three frailty stages on various health domains. BMC Geriatr. 2015 Jul 9;15:77. doi: 10.1186/s12877-015-0078-0. |
| 26624218 | Background | Ritt M, Schwarz C, Kronawitter V, Delinic A, Bollheimer LC, Gassmann KG, Sieber CC. Analysis of Rockwood et Al's Clinical Frailty Scale and Fried et Al's Frailty Phenotype as Predictors of Mortality and Other Clinical Outcomes in Older Patients Who Were Admitted to a Geriatric Ward. J Nutr Health Aging. 2015 Dec;19(10):1043-8. doi: 10.1007/s12603-015-0667-9. |
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| 15528056 | Background | Leffondre K, Abrahamowicz M, Regeasse A, Hawker GA, Badley EM, McCusker J, Belzile E. Statistical measures were proposed for identifying longitudinal patterns of change in quantitative health indicators. J Clin Epidemiol. 2004 Oct;57(10):1049-62. doi: 10.1016/j.jclinepi.2004.02.012. |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D001284 | Atrophy |
| D020763 | Pathological Conditions, Anatomical |
| D012816 | Signs and Symptoms |
| D004812 |
| Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |