Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Ramai, Daryl; Dang-Ho, Khoi Paul; Kewalramani, Anjali; Bandaru, Praneeth; Sacco, Rodolfo; Giacomelli, Luca; Shah, Aashni; Papa, Simonetta; Cappellini, Francesca; Perversi, Fabio; Nunzio, Sara di; Facciorusso, Antonio

doi:10.3390/biomedicines9111693

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…Frailty has been identified as a strong independent factor in reinfarction, in‐hospital mortality, and 30‐day mortality for patients experiencing myocardial infarctions 25 and has also shown implications in pneumonia, heart failure, acute coronary syndrome, valvular replacement, and noncardiac etiologies 26–28 . The Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample (NIS) and Nationwide Readmission Databases (NRD) 29 have been analyzed to determine the effect of frailty on inflammatory bowel diseases, 26 heart failure, 17 transcatheter aortic valve implantations, 27 and hepatocellular carcinoma 30 . Recent literature has also highlighted the benefit of PCI in frail population using the NIS 21 .…”

Section: Introductionmentioning

confidence: 99%

“…[26][27][28] The Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample (NIS) and Nationwide Readmission Databases (NRD) 29 have been analyzed to determine the effect of frailty on inflammatory bowel diseases, 26 heart failure, 17 transcatheter aortic valve implantations, 27 and hepatocellular carcinoma. 30 Recent literature has also highlighted the benefit of PCI in frail population using the NIS. 21 Our study adds to this important finding by analyzing the NRD to determine the impact of frailty on readmissions in acute STEMI patients undergoing PCI.…”

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confidence: 99%

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Impact of frailty on outcomes in acute ST‐elevated myocardial infarctions undergoing percutaneous coronary intervention

Heaton

Singh

Nanavaty

et al. 2023

Cathet Cardio Intervent

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Aims We analyzed the impact of frailty on readmission rates for ST‐elevated myocardial infarctions (STEMIs) and the utilization of percutaneous coronary intervention (PCI) in STEMI admissions. Methods and Results The 2016−2019 Nationwide Readmission Database was analyzed for patients admitted with an acute STEMI. Patients were categorized by frailty risk and analyzed for 30‐day readmission risk after acute STEMIs, PCI utilization and outcomes, and healthcare resource utilization. Qualifying index admissions were found in 584,918 visits. Low risk frailty was noted in 78.20%, intermediate risk in 20.67%, and high risk in 1.14% of admissions. Thirty‐day readmissions occurred in 7.74% of index admissions, increasing with frailty (p < 0.001). Readmission risk increased with frailty, 1.37 times with intermediate and 1.21 times with high‐risk frailty. PCI was performed in 86.40% of low‐risk, 66.03% of intermediate‐risk, and 58.90% of high‐risk patients (p < 0.001). Intermediate patients were 55.02% less likely and high‐risk patients were 61.26% less likely to undergo PCI (p < 0.001). Length of stay means for index admissions were 2.96, 7.83, and 16.32 days for low, intermediate, and high‐risk groups. Intermediate and high‐risk frailty had longer length of stay, higher total cost, and were more likely to be discharged to a skilled facility (p < 0.001). Conclusion Among adult, all‐payer inpatient visits, frailty discerned by the hospital frailty risk score was associated with increased readmissions, increased healthcare resource utilization, and lower PCI administration.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Impact of frailty on outcomes in acute ST‐elevated myocardial infarctions undergoing percutaneous coronary intervention

Heaton

Singh

Nanavaty

et al. 2023

Cathet Cardio Intervent

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“…The HFRS can be easily implemented in hospital electronic information systems, eliminating the inter-operator variability and assessment burden of commonly used frailty tools. The prognostic predictive role of the HFRS has been studied in a variety of patients, including patients with CVD ( 13 ), carcinoma ( 14 ), coronavirus pneumonia ( 15 ), and chronic obstructive pulmonary disease ( 16 ), as well as those receiving various surgical procedures ( 17 – 20 ). However, few studies have investigated the application of the HFRS in patients with AMI.…”

Section: Introductionmentioning

confidence: 99%

Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV

Bai

Hao

Meng

et al. 2022

Front. Cardiovasc. Med.

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BackgroundFrailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients.MethodsData from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes.ResultsAmong 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20–1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24–1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19–3.59 and OR = 2.69, 95% CI: 1.93–3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00–2.69 and HR = 2.81, 95% CI: 2.33–3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality.ConclusionFrailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.

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“…HFRS was derived from data from more than one million older patients in the United Kingdom [ 27 ]. HFRS has been used for assessing frailty in other disease conditions such as heart failure, ruptured intracranial aneurysms, and hepatocellular carcinoma [ 28 , 29 , 30 ]. Although the Fried frailty phenotype is the most used frailty screening measure, we could not use the Fried frailty phenotype because it requires performing physical tests.…”

Section: Introductionmentioning

confidence: 99%

Higher Hospital Frailty Risk Score Is an Independent Predictor of In-Hospital Mortality in Hospitalized Older Adults with Obstructive Sleep Apnea

Ajibawo

Okunowo

2022

Geriatrics

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Background: Frailty predisposes individuals to stressors, increasing morbidity and mortality risk. Therefore, this study examined the impact of frailty defined by the Hospital Frailty Risk Score (HFRS) and other characteristics in older hospitalized patients with Obstructive Sleep Apnea (OSA). Methods: We conducted a retrospective study using the National Inpatient Sample 2016 in patients ≥65 years old with OSA. Logistic regression was used to evaluate the impact of frailty on inpatient mortality. A Kaplan-Meier curve with a log-rank test was used to estimate survival time between frailty groups. Results: 182,174 discharge records of elderly OSA were included in the study. 54% of the cohort were determined to be a medium/high frailty risk, according to HFRS. In multivariable analysis, frailty was associated with a fourfold (medium frailty, adjusted odd ratio (aOR): 4.12, 95% Confidence Interval (CI): 3.76–4.53, p-value < 0.001) and sixfold (high frailty, OR: 6.38, 95% CI: 5.60–7.27, p-value < 0.001) increased odds of mortality. Hospital survival time was significantly different between the three frailty groups (Log-rank test, p < 0.0001). Comorbidity burden defined by Charlson comorbidity Index (CCI) was associated with increased mortality (p < 0.001). Conclusion: More than half of the whole cohort was determined to be at medium and high frailty risk. Frailty was a significant predictor of in-hospital deaths in hospitalized OSA patients. Frailty assessment may be applicable for risk stratification of older hospitalized OSA patients.

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Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Cited by 12 publications

References 30 publications

Impact of frailty on outcomes in acute ST‐elevated myocardial infarctions undergoing percutaneous coronary intervention

Impact of frailty on outcomes in acute ST‐elevated myocardial infarctions undergoing percutaneous coronary intervention

Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV

Higher Hospital Frailty Risk Score Is an Independent Predictor of In-Hospital Mortality in Hospitalized Older Adults with Obstructive Sleep Apnea

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