Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study

Hongye Zhao; Junlan Tu; Quan She; Min Li; Kai Wang; Weihong Zhao; Peng Huang; Bo Chen; Jianqing Wu

doi:10.1186/s12877-023-04029-3

Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study

BMC Geriatr. 2023 May 17;23(1):308. doi: 10.1186/s12877-023-04029-3.

Authors

Hongye Zhao^{1

2}, Junlan Tu³, Quan She¹, Min Li¹, Kai Wang¹, Weihong Zhao¹, Peng Huang³, Bo Chen⁴, Jianqing Wu⁵

Affiliations

¹ 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.
² Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical Unversity, Lianyungang, 222000, China.
³ Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
⁴ 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. bchen@njmu.edu.cn.
⁵ 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. jwuny@njmu.edu.cn.

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.

Keywords: Clinical outcome and prognosis; Elderly patients; FI-Lab; Frailty; community-acquired pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Frail Elderly
Frailty* / diagnosis
Geriatric Assessment
Humans
Male
Pneumonia* / diagnosis
Prognosis
Retrospective Studies