1
|
Zhao H, Tu J, She Q, Li M, Wang K, Zhao W, Huang P, Chen B, Wu J. Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study. BMC Geriatr 2023; 23:308. [PMID: 37198576 DOI: 10.1186/s12877-023-04029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Frailty is associated with poor prognosis in a wide range of illnesses. However, its prognostic implications for older patients with community-acquired pneumonia (CAP) are not adequately addressed. METHODS In this study, patients were classified into 3 groups according to the frailty index based on standard laboratory tests (FI-Lab) score: robust (FI-Lab < 0.2), pre-frail (FI-Lab 0.2-0.35), and frail (FI-Lab ≥ 0.35). The relationships between frailty and all-cause mortality and short-term clinical outcomes (length of stay, duration of antibiotic therapy, in-hospital mortality) were examined. RESULTS Finally, 1164 patients were included, the median age was 75 years (interquartile range: 69, 82), and 438 patients (37.6%) were women. According to FI-Lab, 261(22.4%), 395(33.9%), and 508(43.6%) were robust, pre-frail, and frail. After adjustment for confounding variables, frailty was independently associated with prolonged antibiotic treatment (p = 0.037); pre-frailty and frailty were independently associated with longer inpatient days (p < 0.05 for both). The risk of in-hospital mortality was independently increased in frail patients (HR = 5.01, 95% CI = 1.51-16.57, p = 0.008) but not pre-frail patients (HR = 2.87, 95% CI = 0.86-9.63, p = 0.088) compared to robust patients. During a median follow-up of 33.9 months (interquartile range: 32.8 to 35.1 months), 408 (35.1%) patients died, of whom 29 (7.1%) were robust, 112 (27.5%) were pre-frail, and 267 (65.9%) were frail. Compared to robust patients, frail and pre-frail were significantly associated with increased risk for all-cause death (HR = 4.29, 95%CI: 1.78-10.35 and HR = 2.42 95%CI: 1.01-5.82, respectively). CONCLUSIONS Frailty is common among older patients with CAP and is strongly associated with increased mortality, longer length of stay, and duration of antibiotics. A routine frail assessment at the admission of elderly patients with CAP is necessary as the first step for appropriate multidisciplinary interventions.
Collapse
Affiliation(s)
- Hongye Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
- Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical Unversity, Lianyungang, 222000, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quan She
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Kai Wang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Weihong Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Chen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
| | - Jianqing Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
| |
Collapse
|
2
|
Gu JJ, Liu Q, Zheng LJ. A Frailty Assessment Tool to Predict In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:1093-1100. [PMID: 33907395 PMCID: PMC8068494 DOI: 10.2147/copd.s300980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/21/2021] [Indexed: 01/18/2023] Open
Abstract
Background The exacerbation of chronic obstructive pulmonary disease (AECOPD) is a chronic, frequent, and life-threatening lung disease. In 2014, a frailty index (FI) based on deficits in commonly used laboratory tests (FI-Lab) was suggested to identify older adults at increased risk of death. Objective We aim to study the prognostic value of the FI-Lab in older Chinese patients who were admitted because of AECOPD. Methods We screened 1932 older patients hospitalized with AECOPD from September 2016 to June 2019 at Zhenjiang First People’s Hospital, China. A multivariate logistic regression analysis was used to identify prognostic factors for in-hospital mortality. Results A total of 77 survivors and 77 non-survivors were finally included in the study. Both the mean DECAF (including dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score and the mean FI-Lab value of non-survivors were statistically higher than those of survivors (4.45 ± 0.80 versus 3.03 ± 0.90, P=0.000; 0.51 ± 0.13 versus 0.29 ± 0.10, P=0.000, respectively). Logistic regression analysis suggested that DECAF Rank and FI-Lab Rank were strongly related factors of death in AECOPD patients. The areas under the receiver-operating characteristic (ROC) curves were 0.906 for FI-Lab and 0.870 for DECAF (P=0.2991). Conclusion FI-Lab is a simple, efficient, and objective tool to stratify the risk of in-hospital mortality of AECOPD.
Collapse
Affiliation(s)
- Jin-Jin Gu
- Department of Geriatrics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, People's Republic of China
| | - Qiang Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Li-Jie Zheng
- Department of Laboratory Medicine,The Affiliated People's Hospital of Jiangsu University, Zhejiang, 212002, People's Republic of China
| |
Collapse
|