An electronic medical record-based frailty index as a locally constructed composite risk score associated with septic shock and mortality in older patients with community-acquired pneumonia.

Objective

The clinical and economic burden of community-acquired pneumonia (CAP) is high and increases with age. Current prognostic scores perform poorly in older adults, and additional markers for risk stratification need to be identified for older patients with CAP. This study aimed to examine the associations between a locally constructed electronic medical record-based frailty index (FI) and septic shock and mortality in older patients with CAP.

Methods

This retrospective cohort study was conducted in a teaching hospital in western China. The data of patients ≥ 60 years who had been hospitalized with CAP were acquired from medical records and telephone interviews. The outcomes were septic shock and all-cause mortality. Thirty-six parameters were used to construct a locally derived composite FI for exploratory association analyses, which was then sub-divided into robust (≤0.12), mildly frail (0.12-0.24), moderately frail (0.24-0.36), and severely frail (>0.36) patients.

Results

In all, 751 patients, 61.92% of whom were male and with a median age of 80 years, were included. The septic shock and mortality rates were greater in the severe, moderate, and mild frailty groups compared to those in the robust group (septic shock: 28.04% vs. 18.35% vs. 12.59% vs. 10%, p = 0.001; death: 69.16% vs. 53.24% vs. 31.82% vs. 17.5%, p < 0.001). After adjustment for potential confounders, severe frailty was associated with greater odds of septic shock relative to the robust group (OR=2.879, 95%CI: 1.177-7.041), and mild, moderate, and severe frailty were significantly associated with mortality compared to the patients in the robust health group (mild frailty: HR=1.837, 95% CI: 1.043-3.236; moderate frailty: HR=3.28, 95% CI: 1.878-5.729; severe frailty: HR=4.212, 95% CI: 2.332-7.607).

Conclusions

AND IMPLICATIONS Severe frailty in older patients with CAP was associated with greater odds of septic shock, and mild, moderate, and severe frailty were associated with increased mortality in older patients with CAP. The FI should be interpreted as a population-specific composite risk-stratification score rather than as a validated prognostic tool.