Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/24840
Title: Frailty and outcomes from pneumonia in critical illness: a population-based cohort study.
Austin Authors: Darvall, Jai N;Bellomo, Rinaldo ;Bailey, Michael;Paul, Eldho;Young, Paul J;Rockwood, Kenneth;Pilcher, David
Affiliation: Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Data Analytics Research and Evaluation (DARE) Centre
Medical Research Institute of New Zealand, Wellington, New Zealand
Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
Divisions of Geriatric Medicine & Neurology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
Issue Date: 2-Sep-2020
Date: 2020-09-02
Publication information: British Journal of Anaesthesia 2020; 125(5): 730-738
Abstract: 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. 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. 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]). 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/24840
DOI: 10.1016/j.bja.2020.07.049
Journal: British Journal of Anaesthesia
PubMed URL: 32891413
Type: Journal Article
Subjects: COVID-19
frailty
intensive care unit
mortality
observational study
pneumonia
respiratory failure
Appears in Collections:Journal articles

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