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

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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.

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Most cited references 37

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New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.

Vijaya Sundararajan, Toni Henderson, Catherine Perry … (2004)

The ICD-9-CM adaptation of the Charlson comorbidity score has been a valuable resource for health services researchers. With the transition into ICD-10 coding worldwide, an ICD-10 version of the Deyo adaptation was developed and validated using population-based hospital data from Victoria, Australia. The algorithm was translated from ICD-9-CM into ICD-10-AM (Australian modification) in a multistep process. After a mapping algorithm was used to develop an initial translation, these codes were manually examined by the coding experts and a general physician for face validity. Because the ICD-10 system is country specific, our goal was to keep many of the translated code at the three-digit level for generalizability of the new index. There appears to be little difference in the distribution of the Charlson Index score between the two versions. A strong association between increasing index scores and mortality exists: the area under the ROC curve is 0.865 for the last year using the ICD-9-CM version and remains high, at 0.855, for the ICD-10 version. This work represents the first rigorous adaptation of the Charlson comorbidity index for use with ICD-10 data. In comparison with a well-established ICD-9-CM coding algorithm, it yields closely similar prevalence and prognosis information by comorbidity category.

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Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study

Thomas I. Gilbert, Jenny Neuburger, Joshua Kraindler … (2018)

Summary Background Older people are increasing users of health care globally. We aimed to establish whether older people with characteristics of frailty and who are at risk of adverse health-care outcomes could be identified using routinely collected data. Methods A three-step approach was used to develop and validate a Hospital Frailty Risk Score from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. First, we carried out a cluster analysis to identify a group of older people (≥75 years) admitted to hospital who had high resource use and diagnoses associated with frailty. Second, we created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group. Third, in separate cohorts, we tested how well the score predicted adverse outcomes and whether it identified similar groups as other frailty tools. Findings In the development cohort (n=22 139), older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use (33·6 bed-days over 2 years compared with 23·0 bed-days for the group with the next highest number of bed-days). In the national validation cohort (n=1 013 590), compared with the 429 762 (42·4%) patients with the lowest risk scores, the 202 718 (20·0%) patients with the highest Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% CI 1·68–1·75), long hospital stay (6·03, 5·92–6·10), and 30-day readmission (1·48, 1·46–1·50). The c statistics (ie, model discrimination) between individuals for these three outcomes were 0·60, 0·68, and 0·56, respectively. The Hospital Frailty Risk Score showed fair overlap with dichotomised Fried and Rockwood scales (kappa scores 0·22, 95% CI 0·15–0·30 and 0·30, 0·22–0·38, respectively) and moderate agreement with the Rockwood Frailty Index (Pearson's correlation coefficient 0·41, 95% CI 0·38–0·47). Interpretation The Hospital Frailty Risk Score provides hospitals and health systems with a low-cost, systematic way to screen for frailty and identify a group of patients who are at greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. Funding National Institute for Health Research.

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Frailty Screening and Interventions: Considerations for Clinical Practice.

Jeremy Walston, Brian Buta, Qian-Li Xue (2018)

Frailty is recognized as a cornerstone of geriatric medicine. It increases the risk of geriatric syndromes and adverse health outcomes in older and vulnerable populations. Although multiple screening instruments have been developed and validated to improve feasibility in clinical practice, frequent lack of agreement between frailty instruments has slowed broad implementation of these tools. Despite this, interventions to improve frailty-related health outcomes developed to date include exercise, nutrition, multicomponent interventions, and individually tailored geriatric care models. Possible strategies to prevent frailty include lifestyle or behavioral interventions, proper nutrition, and increased activity levels and social engagement.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Gastroenterol

Journal ID (iso-abbrev): Ann Gastroenterol

Title: Annals of Gastroenterology

Publisher: Hellenic Society of Gastroenterology (Greece )

ISSN (Print): 1108-7471

ISSN (Electronic): 1792-7463

Publication date (Print): Jan-Feb 2023

Publication date (Electronic): 29 November 2022

Volume: 36

Issue: 1

Pages: 73-80

Affiliations

[a ]Liver Institute Northwest, Seattle, WA (Aalam Sohal)

[b ]Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA (Hunza Chaudhry)

[c ]Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA (Isha Kohli)

[d ]Dayanand Medical College and Hospital, Punjab, India (Gagan Gupta, Piyush Singla)

[e ]Punjab Institute of Medical Sciences, Punjab, India (Raghav Sharma)

[f ]Ross University School of Medicine, Bridgetown, Barbados (Dino Dukovic)

[g ]Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Devang Prajapati)

Author notes

Correspondence to: Hunza Chaudhry, MD, 155 N. Fresno St., Fresno, CA 93701, USA e-mail: hunza.chaudhry@ 123456ucsf.edu

[*]

Both authors contributed equally to the manuscript

Article

Publisher ID: AnnGastroenterol-36-73

DOI: 10.20524/aog.2022.0765

PMC ID: 9756028

PubMed ID: 36593805

SO-VID: 25537d47-9b6a-4dc4-8162-ca498cdaeab7

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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

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Abstract

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Most cited references 37

New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.

Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study

Frailty Screening and Interventions: Considerations for Clinical Practice.

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