Top

Published in:

Open Access 01-12-2021 | Research

Association between frailty and mortality among patients with accidental hypothermia: a nationwide observational study in Japan

Authors: Shuhei Takauji, Toru Hifumi, Yasuaki Saijo, Shoji Yokobori, Jun Kanda, Yutaka Kondo, Kei Hayashida, Junya Shimazaki, Takashi Moriya, Masaharu Yagi, Junko Yamaguchi, Yohei Okada, Yuichi Okano, Hitoshi Kaneko, Tatsuho Kobayashi, Motoki Fujita, Keiki Shimizu, Hiroyuki Yokota, Arino Yaguchi

Published in: BMC Geriatrics | Issue 1/2021

Abstract

Background

Frailty has been associated with a risk of adverse outcomes, and mortality in patients with various conditions. However, there have been few studies on whether or not frailty is associated with mortality in patients with accidental hypothermia (AH). In this study, we aim to determine this association in patients with AH using Japan’s nationwide registry data.

Methods

The data from the Hypothermia STUDY 2018&19, which included patients of ≥18 years of age with a body temperature of ≤35 °C, were obtained from a multicenter registry for AH conducted at 120 institutions throughout Japan, collected from December 2018 to February 2019 and December 2019 to February 2020. The clinical frailty scale (CFS) score was used to determine the presence and degree of frailty. The primary outcome was the comparison of mortality between the frail and non-frail patient groups.

Results

In total, 1363 patients were included in the study, of which 920 were eligible for the analysis. The 920 patients were divided into the frail patient group (N = 221) and non-frail patient group (N = 699). After 30-days of hospitalization, 32.6% of frail patients and 20.6% of non-frail patients had died (p < 0.001). Frail patients had a significantly higher risk of 90-day mortality (Hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.25–2.17; p < 0.001). Based on the Cox proportional hazards analysis using multiple imputation, after adjustment for age, potassium level, lactate level, pH value, sex, CPK level, heart rate, platelet count, location of hypothermia incidence, and rate of tracheal intubation, the HR was 1.69 (95% CI, 1.25–2.29; p < 0.001).

Conclusions

This study showed that frailty was associated with mortality in patients with AH. Preventive interventions for frailty may help to avoid death caused by AH.

Available only for authorised users

Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med. 2012;367(20):1930–8. https://doi.org/10.1056/NEJMra1114208.CrossRefPubMed

Silfvast T, Pettilä V. Outcome from severe accidental hypothermia in southern Finland—a 10-year review. Resuscitation. 2003;59(3):285–90. https://doi.org/10.1016/S0300-9572(03)00237-5.CrossRefPubMed

van der Ploeg GJ, Goslings JC, Walpoth BH, Bierens JJ. Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical Centre. Resuscitation. 2010;81(11):1550–5. https://doi.org/10.1016/j.resuscitation.2010.05.023.CrossRefPubMed

Yokota H. The clinical characteristics of hypothermic patients in the winter of Japan-the final report of hypothermia STUDY 2011. J Japan Assoc Acute Med. 2013;24:377–89.

Matsuyama T, Morita S, Ehara N, Miyamae N, Okada Y, Jo T, et al. Characteristics and outcomes of accidental hypothermia in Japan: the J-point registry. Emerg Med J. 2018. https://doi.org/10.1136/emermed-2017-207238.

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet (London, England). 2013;381(9868):752–62.CrossRef

Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet (London, England). 2019;394(10206):1365–75.CrossRef

Silva-Obregon JA, Quintana-Diaz M, Saboya-Sanchez S, Marian-Crespo C, Romera-Ortega MA, Chamorro-Jambrina C, et al. Frailty as a predictor of short- and long-term mortality in critically ill older medical patients. J Crit Care. 2020;55:79–85. https://doi.org/10.1016/j.jcrc.2019.10.018.CrossRefPubMed

Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22. https://doi.org/10.1007/s00134-017-4867-0.CrossRefPubMedPubMedCentral

10.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8.CrossRefPubMed

11.

Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow coma scale at 40 years: standing the test of time. Lancet Neurol. 2014;13(8):844–54. https://doi.org/10.1016/S1474-4422(14)70120-6.CrossRefPubMed

12.

Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800. https://doi.org/10.1097/00003246-199811000-00016.CrossRefPubMed

13.

A randomized clinical trial of calcium entry blocker administration to comatose survivors of cardiac arrest: Design, methods, and patient characteristics. Control Clin Trials. 1991;12(4):525–45.

14.

Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014;21(2):81–8. https://doi.org/10.1097/MEJ.0b013e32836437cf.CrossRefPubMed

15.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. https://doi.org/10.1503/cmaj.050051.CrossRefPubMedPubMedCentral

16.

Takauji S, Hifumi T, Saijo Y, Yokobori S, Kanda J, Kondo Y, et al. Accidental hypothermia: factors related to a prolonged hospital stay – a nationwide observational study in Japan. Am J Emerg Med. 2021;47:169–75. https://doi.org/10.1016/j.ajem.2021.03.079.CrossRefPubMed

17.

Chevret S, Seaman S, Resche-Rigon M. Multiple imputation: a mature approach to dealing with missing data. Intensive Care Med. 2015;41(2):348–50. https://doi.org/10.1007/s00134-014-3624-x.CrossRefPubMedPubMedCentral

18.

White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99. https://doi.org/10.1002/sim.4067.CrossRefPubMed

19.

Marengoni A, Vetrano DL, Manes-Gravina E, Bernabei R, Onder G, Palmer K. The relationship between COPD and frailty: a systematic review and Meta-analysis of observational studies. Chest. 2018;154(1):21–40. https://doi.org/10.1016/j.chest.2018.02.014.CrossRefPubMed

20.

Faye AS, Wen T, Soroush A, Ananthakrishnan AN, Ungaro R, Lawlor G, et al. Increasing prevalence of frailty and its association with readmission and mortality among hospitalized patients with IBD. Dig Dis Sci. 2021. https://doi.org/10.1007/s10620-020-06746-w.

21.

Guaraldi G, Malagoli A, Theou O, Brothers TD, Wallace L, Torelli R, et al. Correlates of frailty phenotype and frailty index and their associations with clinical outcomes. HIV Med. 2017;18(10):764–71. https://doi.org/10.1111/hiv.12527.CrossRefPubMed

22.

Sinclair M, Poltavskiy E, Dodge JL, Lai JC. Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist. World J Gastroenterol. 2017;23(5):899–905. https://doi.org/10.3748/wjg.v23.i5.899.CrossRefPubMedPubMedCentral

23.

Schuijt HJ, Morin ML, Allen E, Weaver MJ. Does the frailty index predict discharge disposition and length of stay at the hospital and rehabilitation facilities? Injury. 2021;52(6):1384–89. https://doi.org/10.1016/j.injury.2021.01.004.

24.

Banning LBD, El Moumni M, Visser L, van Leeuwen BL, Zeebregts CJ, Pol RA. Frailty leads to poor long-term survival in patients undergoing elective vascular surgery. J Vasc Surg. 2021;73(6):2132–9.e2. https://doi.org/10.1016/j.jvs.2020.10.088.

25.

Elbaz G, Etzion O, Delgado J, Porath A, Talmor D, Novack V. Hypothermia in a desert climate: severity score and mortality prediction. Am J Emerg Med. 2008;26(6):683–8. https://doi.org/10.1016/j.ajem.2007.10.016.CrossRefPubMed

26.

Schaller MD, Fischer AP, Perret CH. Hyperkalemia. A prognostic factor during acute severe hypothermia. Jama. 1990;264(14):1842–5. https://doi.org/10.1001/jama.1990.03450140064035.CrossRefPubMed

27.

Okada Y, Matsuyama T, Morita S, Ehara N, Miyamae N, Jo T, et al. Prognostic factors for patients with accidental hypothermia: a multi-institutional retrospective cohort study. Am J Emerg Med. 2019;37(4):565–70. https://doi.org/10.1016/j.ajem.2018.06.025.CrossRefPubMed

28.

de Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millan-Calenti JC. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr. 2015;15(1):154. https://doi.org/10.1186/s12877-015-0155-4.CrossRefPubMedPubMedCentral

29.

Losa-Reyna J, Baltasar-Fernandez I, Alcazar J, Navarro-Cruz R, Garcia-Garcia FJ, Alegre LM, et al. Effect of a short multicomponent exercise intervention focused on muscle power in frail and pre frail elderly: a pilot trial. Exp Gerontol. 2019;115:114–21. https://doi.org/10.1016/j.exger.2018.11.022.CrossRefPubMed

30.

Delaney KA, Vassallo SU, Larkin GL, Goldfrank LR. Rewarming rates in urban patients with hypothermia: prediction of underlying infection. Acad Emerg Med. 2006;13(9):913–21. https://doi.org/10.1197/j.aem.2006.05.022.CrossRefPubMed

31.

Watanabe M, Matsuyama T, Morita S, Ehara N, Miyamae N, Okada Y, et al. Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-point registry. Scand J Trauma Resusc Emerg Med. 2019;27(1):105. https://doi.org/10.1186/s13049-019-0684-5.CrossRefPubMedPubMedCentral

32.

Marik PE, Zaloga GP. Hypothermia and cytokines in septic shock. Norasept II study investigators. North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock. Intensive Care Med. 2000;26(6):716–21. https://doi.org/10.1007/s001340051237.CrossRefPubMed

33.

Kushimoto S, Gando S, Saitoh D, Mayumi T, Ogura H, Fujishima S, et al. The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis. Critical care (London, England). 2013;17(6):R271.CrossRef

34.

Kushimoto S, Abe T, Ogura H, Shiraishi A, Saitoh D, Fujishima S, et al. Impact of body temperature abnormalities on the implementation of Sepsis bundles and outcomes in patients with severe Sepsis: a retrospective sub-analysis of the focused outcome research on emergency Care for Acute Respiratory Distress Syndrome, Sepsis and trauma study. Crit Care Med. 2019;47(5):691–9. https://doi.org/10.1097/CCM.0000000000003688.CrossRefPubMed

35.

Drewry AM, Fuller BM, Skrupky LP, Hotchkiss RS. The presence of hypothermia within 24 hours of sepsis diagnosis predicts persistent lymphopenia. Crit Care Med. 2015;43(6):1165–9. https://doi.org/10.1097/CCM.0000000000000940.CrossRefPubMedPubMedCentral

36.

Drewry AM, Ablordeppey EA, Murray ET, Dalton CM, Fuller BM, Kollef MH, et al. Monocyte function and clinical outcomes in febrile and afebrile patients with severe Sepsis. Shock. 2018;50(4):381–7. https://doi.org/10.1097/SHK.0000000000001083.CrossRefPubMedPubMedCentral

37.

Fernando SM, McIsaac DI, Rochwerg B, Bagshaw SM, Muscedere J, Munshi L, et al. Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med. 2019;45(12):1742–52. https://doi.org/10.1007/s00134-019-05795-8.CrossRefPubMed

38.

Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7. https://doi.org/10.1093/gerona/62.7.722.CrossRefPubMed

39.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. https://doi.org/10.1093/gerona/56.3.M146.CrossRef

40.

Leahy A, O'Connor M, Condon J, Heywood S, Shanahan E, Peters C, et al. Diagnostic and predictive accuracy of the clinical frailty scale among hospitalised older medical patients: a systematic review and meta-analysis protocol. BMJ Open. 2021;11(1):e040765. https://doi.org/10.1136/bmjopen-2020-040765.CrossRefPubMed

Title: Association between frailty and mortality among patients with accidental hypothermia: a nationwide observational study in Japan
Authors: Shuhei Takauji
Toru Hifumi
Yasuaki Saijo
Shoji Yokobori
Jun Kanda
Yutaka Kondo
Kei Hayashida
Junya Shimazaki
Takashi Moriya
Masaharu Yagi
Junko Yamaguchi
Yohei Okada
Yuichi Okano
Hitoshi Kaneko
Tatsuho Kobayashi
Motoki Fujita
Keiki Shimizu
Hiroyuki Yokota
Arino Yaguchi
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02459-5

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review

A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study

Effects of physician visit frequency for Parkinson’s disease treatment on mortality, hospitalization, and costs: a retrospective cohort study

Correction to: Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis

Perspectives of older adults with a chronic condition on functioning, social participation and health: a qualitative study

Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage