Frailty and outcomes from pneumonia in critical illness: a population-based cohort study
AuthorDarvall, JN; Bellomo, R; Bailey, M; Paul, E; Young, PJ; Rockwood, K; Pilcher, D
Source TitleBritish Journal of Anaesthesia
PublisherELSEVIER SCI LTD
Medicine (Austin & Northern Health)
Document TypeJournal Article
CitationsDarvall, J. N., Bellomo, R., Bailey, M., Paul, E., Young, P. J., Rockwood, K. & Pilcher, D. (2020). Frailty and outcomes from pneumonia in critical illness: a population-based cohort study. BRITISH JOURNAL OF ANAESTHESIA, 125 (5), pp.730-738. https://doi.org/10.1016/j.bja.2020.07.049.
Access StatusAccess this item via the Open Access location
Open Access URLPublished version
Background A threshold Clinical Frailty Scale (CFS) of 5 (indicating mild frailty) has been proposed to guide ICU admission for UK patients with coronavirus disease 2019 (COVID-19) pneumonia. However, the impact of frailty on mortality with (non-COVID-19) pneumonia in critical illness is unknown. We examined the triage utility of the CFS in patients with pneumonia requiring ICU. Methods We conducted a retrospective cohort study of adult patients admitted with pneumonia to 170 ICUs in Australia and New Zealand from January 1, 2018 to September 31, 2019. We classified patients as: non-frail (CFS 1–4) frail (CFS 5–8), mild/moderately frail (CFS 5–6),and severe/very severely frail (CFS 7–8). We evaluated mortality (primary outcome) adjusting for site, age, sex, mechanical ventilation, pneumonia type and illness severity. We also compared the proportion of ICU bed-days occupied between frailty categories. Results 1852/5607 (33%) patients were classified as frail, including1291/3056 (42%) of patients aged >65 yr, who would potentially be excluded from ICU admission under UK-based COVID-19 triage guidelines. Only severe/very severe frailty scores were associated with mortality (adjusted odds ratio [aOR] for CFS=7: 3.2; 95% confidence interval [CI]: 1.3–7.8; CFS=8 [aOR: 7.2; 95% CI: 2.6–20.0]). These patients accounted for 7% of ICU bed days. Vulnerability (CFS=4) and mild frailty (CFS=5) were associated with a similar mortality risk (CFS=4 [OR: 1.6; 95% CI: 0.7–3.8]; CFS=5 [OR: 1.6; 95% CI: 0.7–3.9]). Conclusions Patients with severe and very severe frailty account for relatively few ICU bed days as a result of pneumonia, whilst adjusted mortality analysis indicated little difference in risk between patients in vulnerable, mild, and moderate frailty categories. These data do not support CFS ≥5 to guide ICU admission for pneumonia.
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