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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.date.accessioned2020-12-16T23:51:55Z
dc.date.available2020-12-16T23:51:55Z
dc.date.issued2020-11-01
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. https://doi.org/10.1016/j.bja.2020.07.049.
dc.identifier.issn0007-0912
dc.identifier.urihttp://hdl.handle.net/11343/254602
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.languageEnglish
dc.publisherELSEVIER SCI LTD
dc.titleFrailty and outcomes from pneumonia in critical illness: a population-based cohort study
dc.typeJournal Article
dc.identifier.doi10.1016/j.bja.2020.07.049
melbourne.affiliation.departmentMedicine and Radiology
melbourne.affiliation.departmentMedical Education
melbourne.source.titleBritish Journal of Anaesthesia
melbourne.source.volume125
melbourne.source.issue5
melbourne.source.pages730-738
melbourne.elementsid1464638
melbourne.openaccess.urlhttps://europepmc.org/articles/PMC7467940?pdf=render
melbourne.openaccess.statusPublished version
melbourne.contributor.authorDarvall, Jai
melbourne.contributor.authorBellomo, Rinaldo
melbourne.contributor.authorBailey, Michael
melbourne.contributor.authorPIlcher, David
dc.identifier.eissn1471-6771
melbourne.accessrightsAccess this item via the Open Access location


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