Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales

Abstract The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frail...

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Autores principales:	Tamas Szakmany, Joe Hollinghurst, Richard Pugh, Ashley Akbari, Rowena Griffiths, Rowena Bailey, Ronan A. Lyons
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5aae521070ae40d0889a6a6675da232d
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spelling	oai:doaj.org-article:5aae521070ae40d0889a6a6675da232d2021-12-02T18:18:51ZFrailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales10.1038/s41598-021-92874-w2045-2322https://doaj.org/article/5aae521070ae40d0889a6a6675da232d2021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92874-whttps://doaj.org/toc/2045-2322Abstract The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frailty on mortality. Longitudinal cohort study between 2010–2018 using population-scale anonymised data linkage of healthcare records for adults admitted to hospital with pneumonia in Wales. Primary outcome was in-patient mortality. Odds Ratios (ORs [95% confidence interval]) for age, hospital frailty risk score (HFRS), electronic frailty index (eFI), Charlson comorbidity index (CCI), and social deprivation index were estimated using multivariate logistic regression models. The area under the receiver operating characteristic curve (AUC) was estimated to determine the best fitting models. Of the 107,188 patients, mean (SD) age was 72.6 (16.6) years, 50% were men. The models adjusted for the two frailty indices and the comorbidity index had an increased odds of in-patient mortality for individuals with an ICU admission (ORs for ICU admission in the eFI model 2.67 [2.55, 2.79], HFRS model 2.30 [2.20, 2.41], CCI model 2.62 [2.51, 2.75]). Models indicated advancing age, increased frailty and comorbidity were also associated with an increased odds of in-patient mortality (eFI, baseline fit, ORs: mild 1.09 [1.04, 1.13], moderate 1.13 [1.08, 1.18], severe 1.17 [1.10, 1.23]. HFRS, baseline low, ORs: intermediate 2.65 [2.55, 2.75], high 3.31 [3.17, 3.45]). CCI, baseline < 1, ORs: ‘1–10′ 1.15 [1.11, 1.20], > 10 2.50 [2.41, 2.60]). For predicting inpatient deaths, the CCI and HFRS based models were similar, however for longer term outcomes the CCI based model was superior. Frailty and comorbidity are significant risk factors for patients admitted to hospital with pneumonia. Frailty and comorbidity scores based on administrative data have only moderate ability to predict outcome.Tamas SzakmanyJoe HollinghurstRichard PughAshley AkbariRowena GriffithsRowena BaileyRonan A. LyonsNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Tamas Szakmany Joe Hollinghurst Richard Pugh Ashley Akbari Rowena Griffiths Rowena Bailey Ronan A. Lyons Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
description	Abstract The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frailty on mortality. Longitudinal cohort study between 2010–2018 using population-scale anonymised data linkage of healthcare records for adults admitted to hospital with pneumonia in Wales. Primary outcome was in-patient mortality. Odds Ratios (ORs [95% confidence interval]) for age, hospital frailty risk score (HFRS), electronic frailty index (eFI), Charlson comorbidity index (CCI), and social deprivation index were estimated using multivariate logistic regression models. The area under the receiver operating characteristic curve (AUC) was estimated to determine the best fitting models. Of the 107,188 patients, mean (SD) age was 72.6 (16.6) years, 50% were men. The models adjusted for the two frailty indices and the comorbidity index had an increased odds of in-patient mortality for individuals with an ICU admission (ORs for ICU admission in the eFI model 2.67 [2.55, 2.79], HFRS model 2.30 [2.20, 2.41], CCI model 2.62 [2.51, 2.75]). Models indicated advancing age, increased frailty and comorbidity were also associated with an increased odds of in-patient mortality (eFI, baseline fit, ORs: mild 1.09 [1.04, 1.13], moderate 1.13 [1.08, 1.18], severe 1.17 [1.10, 1.23]. HFRS, baseline low, ORs: intermediate 2.65 [2.55, 2.75], high 3.31 [3.17, 3.45]). CCI, baseline < 1, ORs: ‘1–10′ 1.15 [1.11, 1.20], > 10 2.50 [2.41, 2.60]). For predicting inpatient deaths, the CCI and HFRS based models were similar, however for longer term outcomes the CCI based model was superior. Frailty and comorbidity are significant risk factors for patients admitted to hospital with pneumonia. Frailty and comorbidity scores based on administrative data have only moderate ability to predict outcome.
format	article
author	Tamas Szakmany Joe Hollinghurst Richard Pugh Ashley Akbari Rowena Griffiths Rowena Bailey Ronan A. Lyons
author_facet	Tamas Szakmany Joe Hollinghurst Richard Pugh Ashley Akbari Rowena Griffiths Rowena Bailey Ronan A. Lyons
author_sort	Tamas Szakmany
title	Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
title_short	Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
title_full	Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
title_fullStr	Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
title_full_unstemmed	Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales
title_sort	frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and icu in wales
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/5aae521070ae40d0889a6a6675da232d
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Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales

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