Resumen
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.
| Idioma original | English |
|---|---|
| Páginas (desde-hasta) | 730-738 |
| Número de páginas | 9 |
| Publicación | British Journal of Anaesthesia |
| Volumen | 125 |
| N.º | 5 |
| DOI | |
| Estado | Published - nov. 2020 |
Nota bibliográfica
Funding Information:This research was conducted during the tenure of a Health Research Council of New Zealand Clinical Practitioner Fellowship held by PJY. The Medical Research Institute of New Zealand is supported by Independent Research Organisation funding from the Health Research Council of New Zealand.KR reports personal fees from Clinical Cardio Day, Cape Breton University; CRUIGM Montreal; speaker at Jackson Laboratory, Bar Harbor, ME; speaker at MouseAGE, Rome Italy; Lundbeck; Frontemporal Dementia Study Group; and Sun Life Insurance, Japan, outside the submitted work. KR is President and Chief Science Officer of DGI Clinical, which, in the last 5 yr has contracts with pharma and device manufacturers (Baxter, Baxalta, Shire, Hollister, Nutricia, Roche, and Otsuka) on individualised outcome measurement. In 2017, he attended an advisory board meeting with Lundbeck. Otherwise, any personal fees are for invited guest lectures and academic symposia, received directly from event organisers, chiefly for presentations on frailty. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research and with additional funding from the Alzheimer Society of Canada and several other charities, and, in its first phase (2013–8), from Pfizer Canada and Sanofi Canada. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and research support from the Canadian Institutes of Health Research, QEII Health Sciences Centre Foundation, Capital Health Research Fund, and the Fountain Family Innovation Fund of the QEII Health Sciences Centre Foundation.
Funding Information:
This research was conducted during the tenure of a Health Research Council of New Zealand Clinical Practitioner Fellowship held by PJY. The Medical Research Institute of New Zealand is supported by Independent Research Organisation funding from the Health Research Council of New Zealand .
Funding Information:
KR reports personal fees from Clinical Cardio Day, Cape Breton University; CRUIGM Montreal; speaker at Jackson Laboratory, Bar Harbor, ME; speaker at MouseAGE, Rome Italy; Lundbeck; Frontemporal Dementia Study Group; and Sun Life Insurance, Japan, outside the submitted work. KR is President and Chief Science Officer of DGI Clinical, which, in the last 5 yr has contracts with pharma and device manufacturers (Baxter, Baxalta, Shire, Hollister, Nutricia, Roche, and Otsuka) on individualised outcome measurement. In 2017, he attended an advisory board meeting with Lundbeck. Otherwise, any personal fees are for invited guest lectures and academic symposia, received directly from event organisers, chiefly for presentations on frailty. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research and with additional funding from the Alzheimer Society of Canada and several other charities, and, in its first phase (2013–8), from Pfizer Canada and Sanofi Canada. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and research support from the Canadian Institutes of Health Research, QEII Health Sciences Centre Foundation, Capital Health Research Fund, and the Fountain Family Innovation Fund of the QEII Health Sciences Centre Foundation.
Publisher Copyright:
© 2020 British Journal of Anaesthesia
ASJC Scopus Subject Areas
- Anesthesiology and Pain Medicine