Comparison of Frailty Index to Pneumonia Severity Measures in Older Patients With Pneumonia

Abstract

Objectives: Risk stratification tools are useful to provide appropriate clinical care for older patients with pneumonia. This study aimed to compare a Frailty Index (FI) with pneumonia severity measures, CURB-65, and the Pneumonia Severity Index (PSI), for predicting mortality and persistent disability after pneumonia.

Design: Single-center prospective cohort study. Setting and Participants: The study included 190 patients aged >= 65 years who were hospitalized with pneumonia at a university hospital in Korea between October 2019 and September 2020.

Methods: At admission, a 50-item deficit-accumulation FI (range: 0-1), CURB-65 (range: 0-5), and PSI (range: 0-395) scores were calculated. The outcomes were death and a composite outcome of death or decline in ability to perform daily activities and physical task 6 months later.

Results: The median age was 79 years (interquartile range: 74-85), and 70 (36.8%) patients were women. The patients who died (n = 53) had higher FI (median, 0.46 vs 0.20; P <.011), CURB- 65 score (median, 3 vs 2; P=.001), and PSI score (median, 149 vs 116; P <.001) than those who did not. The C-statistics (95% confidence intervals) for 6-month mortality were 0.69 (0.61-0.77) for the FI, 0.62 (0.53-0.71) for CURB-65, and 0.71 (0.62-0.79) for the PSI (P=.019). The C-statistics for the 6-month composite outcome were 0.73 (0.65-0.81) for the FI, 0.64 (0.55-0.73) for CURB-65, and 0.69 (0.60-0.77) for the PSI (P=.096). The C-statistics improved when the FI was added to CURB-65 (from 0.64 to 0.74; P=.003) and to the PSI (from 0.69 to 0.75; P=.044) for the composite outcome.

Conclusions and Implications: Measuring frailty provides additive value to widely used pneumonia severity measures in predicting death or persistent hospitalization-associated disability in older adults after pneumonia hospitalization. Early recognition of frailty may be useful to identify those who require in-hospital and post-acute care interventions for functional recovery. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.