Dataset Information

Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis.

ABSTRACT:

Background

Chronic pancreatitis (CP) is a pathological fibroinflammatory response to persistent inflammation or stress to the pancreas. The effect of frailty on outcomes in patients with CP has not been previously examined. In this study, we examined the effect of frailty on outcomes in hospitalized patients with CP.

Methods

Records of patients with a primary or secondary discharge diagnosis of CP (ICD10-CM codes K86.0, K86.1) between January 2016 and December 2019 were obtained from the National Inpatient Sample database. Data were collected on patient demographics, hospital characteristics, comorbidities, and etiology of CP. The relationship between frailty and outcomes, including mortality, intensive care unit (ICU) admission, sepsis, shock, length of stay (LOS), and total hospitalization charges (THC), were analyzed using multivariate analysis.

Results

722,160 patients were included in the analysis. Patients with a high hospital frailty risk score had a higher mortality risk (adjusted odds ratio [aOR] 12.57, 95% confidence interval [CI] 10.42-15.16; P<0.001) compared to patients with low frailty scores. Patients with high frailty scores also had a higher risk of sepsis (aOR 5.75, 95%CI 4.97-6.66; P<0.001), shock (aOR- 26.25, 95%CI-22.83-30.19; P<0.001), ICU admission (aOR 25.86, 95% CI-22.58-29.62; P<0.001), and acute kidney injury (aOR 24.4, 95%CI 22.39-26.66; P<0.001). They also had a longer LOS (7.04 days, 95%CI 6.57-7.52; P<0.001) and higher THC ($72,200, 95%CI 65,904.52-78,496.66; P<0.001).

Conclusions

Frail patients, as determined by their hospital frailty risk score, are at high risk of worse outcomes. This data suggests opportunities for physicians to risk-stratify patients and predict outcomes.

SUBMITTER: Sohal A

PROVIDER: S-EPMC9756028 | biostudies-literature | 2023 Jan-Feb

REPOSITORIES: biostudies-literature

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Publications

Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis.

Sohal Aalam A Chaudhry Hunza H Kohli Isha I Gupta Gagan G Singla Piyush P Sharma Raghav R Dukovic Dino D Prajapati Devang D

Annals of gastroenterology 20221129 1

<h4>Background</h4>Chronic pancreatitis (CP) is a pathological fibroinflammatory response to persistent inflammation or stress to the pancreas. The effect of frailty on outcomes in patients with CP has not been previously examined. In this study, we examined the effect of frailty on outcomes in hospitalized patients with CP.<h4>Methods</h4>Records of patients with a primary or secondary discharge diagnosis of CP (ICD10-CM codes K86.0, K86.1) between January 2016 and December 2019 were obtained f ...[more]

PMID: 36593805

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Project description:ImportanceFrailty is associated with severe morbidity and mortality among people with chronic obstructive pulmonary disease (COPD). Interventions such as pulmonary rehabilitation can treat and reverse frailty, yet frailty is not routinely measured in pulmonary clinical practice. It is unclear how population-based administrative data tools to screen for frailty compare with standard bedside assessments in this population.ObjectiveTo determine the agreement between the Hospital Frailty Risk Score (HFRS) and the Clinical Frailty Scale (CFS) among hospitalized individuals with COPD and to determine the sensitivity and specificity of the HFRS (vs CFS) to detect frailty.Design, setting, and participantsA cross-sectional study was conducted among hospitalized patients with COPD exacerbation. The study was conducted in the respiratory ward of a single tertiary care academic hospital (The Ottawa Hospital, Ottawa, Ontario, Canada). Participants included consenting adult inpatients who were admitted with a diagnosis of acute COPD exacerbation from December 2016 to June 2019 and who used a clinical care pathway for COPD. There were no specific exclusion criteria. Data analysis was performed in March 2022.ExposureDegree of frailty measured by the CFS.Main outcomes and measuresThe HFRS was calculated using hospital administrative data. Primary outcomes were the sensitivity and specificity of the HFRS to detect frail and nonfrail individuals according to CFS assessments of frailty, and the secondary outcome was the optimal probability threshold of the HFRS to discriminate frail and nonfrail individuals.ResultsAmong 99 patients with COPD exacerbation (mean [SD] age, 70.6 [9.5] years; 56 women [57%]), 14 (14%) were not frail, 33 (33%) were vulnerable, 18 (18%) were mildly frail, and 34 (34%) were moderately to severely frail by the CFS. The HFRS (vs CFS) had a sensitivity of 27% and specificity of 93% to detect frail vs nonfrail individuals. The optimal probability threshold for the HFRS was 1.4 points or higher. The corresponding sensitivity to detect frailty was 69%, and the specificity was 57%.Conclusions and relevanceIn this cross-sectional study, using the population-based HFRS to screen for frailty yielded poor detection of frailty among hospitalized patients with COPD compared with the bedside CFS. These findings suggest that use of the HFRS in this population may result in important missed opportunities to identify and provide early intervention for frailty, such as pulmonary rehabilitation.

Project description:BackgroundWe aimed to compare the agreement between two common frailty assessment tools, Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), and their ability to predict mid-term adverse outcomes in older patients admitted with acute coronary syndrome (ACS).MethodsWe conducted a prospective analysis of patients aged ≥ 60 admitted with ACS at multiple centers in Vietnam between July 2022 and June 2023. A cross-tabulation method was used to describe the correlation between CFS and HFRS. To test the predictive accuracy of HFRS for identifying patients with frailty according to CFS, we evaluated the area under the curves of receiver operating characteristic (ROC) analysis. Youden J index was used to identify a new optimal probability threshold for HFRS. We employed Cox regression models to investigate the association between frailty assessed by CFS, HFRS (using both old and new cut-offs), and 9-month mortality.ResultsWe included 504 older patients admitted with ACS (median age 72.7 years; male: 59.9%). The correlation between CFS and HFRS was fair (AUC = 0.787, p < 0.010). HFRS had a sensitivity of 39.7% and a specificity of 79.2% to detect frailty based on CFS classification. The new optimal probability threshold of HFRS (≥ 1.15 points) improved the instrument's performance with a significantly higher sensitivity of 90.2%. While frailty categorized by HFRS with the original cut-off did not impact mid-term all-cause and cardiovascular mortality, frailty according to CFS and HFRS with the new threshold was shown to be a predictor of mid-term all-cause and cardiovascular mortality (HR = 4.48, p < 0.001 vs. HR = 2.29, p = 0.001; HR = 5.19, p < 0.001 vs. HR = 1.99, p = 0.020).ConclusionsAlthough a fair correlation existed between the CFS and the HFRS in older patients with ACS, HFRS demonstrated limited predictive validity for mid-term mortality. We advocate for a revised cutoff (HFRS ≥ 1.15 points) to enhance its sensitivity and predictive accuracy. Future research should prioritize the integration of additional clinical biomarkers and conducting longitudinal studies to assess the efficacy of targeted interventions informed by frailty scores, ultimately striving to improve outcomes in this vulnerable population.

Dataset Information

Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis.

Background

Methods

Results

Conclusions

Publications

Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis.

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