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dc.contributor.authorDarvall, JN
dc.contributor.authorBellomo, R
dc.contributor.authorBailey, M
dc.contributor.authorPaul, E
dc.contributor.authorYoung, PJ
dc.contributor.authorRockwood, K
dc.contributor.authorPilcher, D
dc.identifierpii: S0007-0912(20)30642-5
dc.identifier.citationDarvall, 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.
dc.description.abstractBackground 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.
dc.publisherELSEVIER SCI LTD
dc.titleFrailty and outcomes from pneumonia in critical illness: a population-based cohort study
dc.typeJournal Article
melbourne.affiliation.departmentMedicine and Radiology
melbourne.affiliation.departmentMedical Education
melbourne.source.titleBritish Journal of Anaesthesia
melbourne.openaccess.statusPublished version
melbourne.contributor.authorDarvall, Jai
melbourne.contributor.authorBellomo, Rinaldo
melbourne.contributor.authorBailey, Michael
melbourne.contributor.authorPIlcher, David
melbourne.accessrightsAccess this item via the Open Access location

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