Association of frailty with short-term outcomes, organ support and resource use in critically ill patients
Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term out...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Zampieri, Fernando G. [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2018 |
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| Schlagwörter: |
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| Anmerkung: |
© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 |
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| Übergeordnetes Werk: |
Enthalten in: Intensive care medicine - Berlin : Springer, 1975, 44(2018), 9 vom: 13. Aug., Seite 1512-1520 |
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| Übergeordnetes Werk: |
volume:44 ; year:2018 ; number:9 ; day:13 ; month:08 ; pages:1512-1520 |
| Links: |
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| DOI / URN: |
10.1007/s00134-018-5342-2 |
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| Katalog-ID: |
SPR001244442 |
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| 100 | 1 | |a Zampieri, Fernando G. |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
| 264 | 1 | |c 2018 | |
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| 337 | |a Computermedien |b c |2 rdamedia | ||
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| 500 | |a © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 | ||
| 520 | |a Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. | ||
| 650 | 4 | |a Frailty |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Modified frailty index |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Organ support |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Resource use |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Outcomes |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Critical care |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Iwashyna, Theodore J. |4 aut | |
| 700 | 1 | |a Viglianti, Elizabeth M. |4 aut | |
| 700 | 1 | |a Taniguchi, Leandro U. |4 aut | |
| 700 | 1 | |a Viana, William N. |4 aut | |
| 700 | 1 | |a Costa, Roberto |4 aut | |
| 700 | 1 | |a Corrêa, Thiago D. |4 aut | |
| 700 | 1 | |a Moreira, Carlos Eduardo N. |4 aut | |
| 700 | 1 | |a Maia, Marcelo O. |4 aut | |
| 700 | 1 | |a Moralez, Giulliana M. |4 aut | |
| 700 | 1 | |a Lisboa, Thiago |4 aut | |
| 700 | 1 | |a Ferez, Marcus A. |4 aut | |
| 700 | 1 | |a Freitas, Carlos Eduardo F. |4 aut | |
| 700 | 1 | |a de Carvalho, Clayton B. |4 aut | |
| 700 | 1 | |a Mazza, Bruno F. |4 aut | |
| 700 | 1 | |a Lima, Mariza F. A. |4 aut | |
| 700 | 1 | |a Ramos, Grazielle V. |4 aut | |
| 700 | 1 | |a Silva, Aline R. |4 aut | |
| 700 | 1 | |a Bozza, Fernando A. |4 aut | |
| 700 | 1 | |a Salluh, Jorge. I. F. |4 aut | |
| 700 | 1 | |a Soares, Marcio |0 (orcid)0000-0003-2503-6088 |4 aut | |
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10.1007/s00134-018-5342-2 doi (DE-627)SPR001244442 (SPR)s00134-018-5342-2-e DE-627 ger DE-627 rakwb eng Zampieri, Fernando G. verfasserin aut Association of frailty with short-term outcomes, organ support and resource use in critically ill patients 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 Iwashyna, Theodore J. aut Viglianti, Elizabeth M. aut Taniguchi, Leandro U. aut Viana, William N. aut Costa, Roberto aut Corrêa, Thiago D. aut Moreira, Carlos Eduardo N. aut Maia, Marcelo O. aut Moralez, Giulliana M. aut Lisboa, Thiago aut Ferez, Marcus A. aut Freitas, Carlos Eduardo F. aut de Carvalho, Clayton B. aut Mazza, Bruno F. aut Lima, Mariza F. A. aut Ramos, Grazielle V. aut Silva, Aline R. aut Bozza, Fernando A. aut Salluh, Jorge. I. F. aut Soares, Marcio (orcid)0000-0003-2503-6088 aut Enthalten in Intensive care medicine Berlin : Springer, 1975 44(2018), 9 vom: 13. Aug., Seite 1512-1520 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:44 year:2018 number:9 day:13 month:08 pages:1512-1520 https://dx.doi.org/10.1007/s00134-018-5342-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 44 2018 9 13 08 1512-1520 |
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10.1007/s00134-018-5342-2 doi (DE-627)SPR001244442 (SPR)s00134-018-5342-2-e DE-627 ger DE-627 rakwb eng Zampieri, Fernando G. verfasserin aut Association of frailty with short-term outcomes, organ support and resource use in critically ill patients 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 Iwashyna, Theodore J. aut Viglianti, Elizabeth M. aut Taniguchi, Leandro U. aut Viana, William N. aut Costa, Roberto aut Corrêa, Thiago D. aut Moreira, Carlos Eduardo N. aut Maia, Marcelo O. aut Moralez, Giulliana M. aut Lisboa, Thiago aut Ferez, Marcus A. aut Freitas, Carlos Eduardo F. aut de Carvalho, Clayton B. aut Mazza, Bruno F. aut Lima, Mariza F. A. aut Ramos, Grazielle V. aut Silva, Aline R. aut Bozza, Fernando A. aut Salluh, Jorge. I. F. aut Soares, Marcio (orcid)0000-0003-2503-6088 aut Enthalten in Intensive care medicine Berlin : Springer, 1975 44(2018), 9 vom: 13. Aug., Seite 1512-1520 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:44 year:2018 number:9 day:13 month:08 pages:1512-1520 https://dx.doi.org/10.1007/s00134-018-5342-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 44 2018 9 13 08 1512-1520 |
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10.1007/s00134-018-5342-2 doi (DE-627)SPR001244442 (SPR)s00134-018-5342-2-e DE-627 ger DE-627 rakwb eng Zampieri, Fernando G. verfasserin aut Association of frailty with short-term outcomes, organ support and resource use in critically ill patients 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 Iwashyna, Theodore J. aut Viglianti, Elizabeth M. aut Taniguchi, Leandro U. aut Viana, William N. aut Costa, Roberto aut Corrêa, Thiago D. aut Moreira, Carlos Eduardo N. aut Maia, Marcelo O. aut Moralez, Giulliana M. aut Lisboa, Thiago aut Ferez, Marcus A. aut Freitas, Carlos Eduardo F. aut de Carvalho, Clayton B. aut Mazza, Bruno F. aut Lima, Mariza F. A. aut Ramos, Grazielle V. aut Silva, Aline R. aut Bozza, Fernando A. aut Salluh, Jorge. I. F. aut Soares, Marcio (orcid)0000-0003-2503-6088 aut Enthalten in Intensive care medicine Berlin : Springer, 1975 44(2018), 9 vom: 13. Aug., Seite 1512-1520 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:44 year:2018 number:9 day:13 month:08 pages:1512-1520 https://dx.doi.org/10.1007/s00134-018-5342-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 44 2018 9 13 08 1512-1520 |
| allfieldsGer |
10.1007/s00134-018-5342-2 doi (DE-627)SPR001244442 (SPR)s00134-018-5342-2-e DE-627 ger DE-627 rakwb eng Zampieri, Fernando G. verfasserin aut Association of frailty with short-term outcomes, organ support and resource use in critically ill patients 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 Iwashyna, Theodore J. aut Viglianti, Elizabeth M. aut Taniguchi, Leandro U. aut Viana, William N. aut Costa, Roberto aut Corrêa, Thiago D. aut Moreira, Carlos Eduardo N. aut Maia, Marcelo O. aut Moralez, Giulliana M. aut Lisboa, Thiago aut Ferez, Marcus A. aut Freitas, Carlos Eduardo F. aut de Carvalho, Clayton B. aut Mazza, Bruno F. aut Lima, Mariza F. A. aut Ramos, Grazielle V. aut Silva, Aline R. aut Bozza, Fernando A. aut Salluh, Jorge. I. F. aut Soares, Marcio (orcid)0000-0003-2503-6088 aut Enthalten in Intensive care medicine Berlin : Springer, 1975 44(2018), 9 vom: 13. Aug., Seite 1512-1520 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:44 year:2018 number:9 day:13 month:08 pages:1512-1520 https://dx.doi.org/10.1007/s00134-018-5342-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 44 2018 9 13 08 1512-1520 |
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10.1007/s00134-018-5342-2 doi (DE-627)SPR001244442 (SPR)s00134-018-5342-2-e DE-627 ger DE-627 rakwb eng Zampieri, Fernando G. verfasserin aut Association of frailty with short-term outcomes, organ support and resource use in critically ill patients 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 Iwashyna, Theodore J. aut Viglianti, Elizabeth M. aut Taniguchi, Leandro U. aut Viana, William N. aut Costa, Roberto aut Corrêa, Thiago D. aut Moreira, Carlos Eduardo N. aut Maia, Marcelo O. aut Moralez, Giulliana M. aut Lisboa, Thiago aut Ferez, Marcus A. aut Freitas, Carlos Eduardo F. aut de Carvalho, Clayton B. aut Mazza, Bruno F. aut Lima, Mariza F. A. aut Ramos, Grazielle V. aut Silva, Aline R. aut Bozza, Fernando A. aut Salluh, Jorge. I. F. aut Soares, Marcio (orcid)0000-0003-2503-6088 aut Enthalten in Intensive care medicine Berlin : Springer, 1975 44(2018), 9 vom: 13. Aug., Seite 1512-1520 (DE-627)253724104 (DE-600)1459201-0 1432-1238 nnns volume:44 year:2018 number:9 day:13 month:08 pages:1512-1520 https://dx.doi.org/10.1007/s00134-018-5342-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 AR 44 2018 9 13 08 1512-1520 |
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Zampieri, Fernando G. @@aut@@ Iwashyna, Theodore J. @@aut@@ Viglianti, Elizabeth M. @@aut@@ Taniguchi, Leandro U. @@aut@@ Viana, William N. @@aut@@ Costa, Roberto @@aut@@ Corrêa, Thiago D. @@aut@@ Moreira, Carlos Eduardo N. @@aut@@ Maia, Marcelo O. @@aut@@ Moralez, Giulliana M. @@aut@@ Lisboa, Thiago @@aut@@ Ferez, Marcus A. @@aut@@ Freitas, Carlos Eduardo F. @@aut@@ de Carvalho, Clayton B. @@aut@@ Mazza, Bruno F. @@aut@@ Lima, Mariza F. A. @@aut@@ Ramos, Grazielle V. @@aut@@ Silva, Aline R. @@aut@@ Bozza, Fernando A. @@aut@@ Salluh, Jorge. I. F. @@aut@@ Soares, Marcio @@aut@@ |
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Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. 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Zampieri, Fernando G. |
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Zampieri, Fernando G. misc Frailty misc Modified frailty index misc Organ support misc Resource use misc Outcomes misc Critical care Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients Frailty (dpeaa)DE-He213 Modified frailty index (dpeaa)DE-He213 Organ support (dpeaa)DE-He213 Resource use (dpeaa)DE-He213 Outcomes (dpeaa)DE-He213 Critical care (dpeaa)DE-He213 |
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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
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Intensive care medicine |
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Zampieri, Fernando G. Iwashyna, Theodore J. Viglianti, Elizabeth M. Taniguchi, Leandro U. Viana, William N. Costa, Roberto Corrêa, Thiago D. Moreira, Carlos Eduardo N. Maia, Marcelo O. Moralez, Giulliana M. Lisboa, Thiago Ferez, Marcus A. Freitas, Carlos Eduardo F. de Carvalho, Clayton B. Mazza, Bruno F. Lima, Mariza F. A. Ramos, Grazielle V. Silva, Aline R. Bozza, Fernando A. Salluh, Jorge. I. F. Soares, Marcio |
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Zampieri, Fernando G. |
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10.1007/s00134-018-5342-2 |
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association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
| abstract |
Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 |
| abstractGer |
Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 |
| abstract_unstemmed |
Purpose Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. Methods Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses. Results The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased. Conclusions Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support. © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018 |
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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients |
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https://dx.doi.org/10.1007/s00134-018-5342-2 |
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Iwashyna, Theodore J. Viglianti, Elizabeth M. Taniguchi, Leandro U. Viana, William N. Costa, Roberto Corrêa, Thiago D. Moreira, Carlos Eduardo N. Maia, Marcelo O. Moralez, Giulliana M. Lisboa, Thiago Ferez, Marcus A. Freitas, Carlos Eduardo F. de Carvalho, Clayton B. Mazza, Bruno F. Lima, Mariza F. A. Ramos, Grazielle V. Silva, Aline R. Bozza, Fernando A. Salluh, Jorge. I. F. Soares, Marcio |
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Iwashyna, Theodore J. Viglianti, Elizabeth M. Taniguchi, Leandro U. Viana, William N. Costa, Roberto Corrêa, Thiago D. Moreira, Carlos Eduardo N. Maia, Marcelo O. Moralez, Giulliana M. Lisboa, Thiago Ferez, Marcus A. Freitas, Carlos Eduardo F. de Carvalho, Clayton B. Mazza, Bruno F. Lima, Mariza F. A. Ramos, Grazielle V. Silva, Aline R. Bozza, Fernando A. Salluh, Jorge. I. F. Soares, Marcio |
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2024-07-03T21:17:10.242Z |
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| score |
7.399928 |