Hospital Frailty Risk Score Predicts Outcomes in Chronic Obstructive Pulmonary Disease Exacerbations

Ushida, Kenta; Shimizu, Akio; Hori, Shinsuke; Yamamoto, Yoshinori; Momosaki, Ryo

doi:10.1016/j.archger.2022.104658

Cited by 22 publications

(37 citation statements)

References 25 publications

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“…Gilbert et al [ 9 ] reported that, among patients aged > 75 years admitted to an acute care hospital, those with a high frailty risk had a nearly two-fold increase in 30-day mortality and a six-fold increase in the risk of long-term hospitalization compared to those with a low frailty risk. Subsequent studies have examined the association between HFRS and adverse events in patients admitted to medical facilities [ 23 ] with stroke/transient ischemic attack [ 24 ], hip fracture surgery [ 25 ], total hip and knee arthroplasty [ 26 ], osteoarthritis [ 27 ], chronic obstructive pulmonary disease [ 28 ], and heart failure [ 29 ]. These reports stated that HFRS could predict adverse events during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…In HFRS, there is a greater weighting of ICD-10 codes for cerebrovascular, motor, gait, and cognitive disabilities [ 9 ]. HFRS includes diseases based on ICD-10 codes that affect functional outcomes [ 9 , 28 ]. Thus, patients at a higher risk of frailty are more likely to present with comorbidities that affect functional recovery more.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, patients at a higher risk of frailty are more likely to present with comorbidities that affect functional recovery more. HFRS has fewer comorbidities that are directly related to death than functional impairment and has less accuracy in predicting death [ 28 , 31 ]. Therefore, HFRS could be a useful predictive tool for functional prognoses, such as ADL, rather than death.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Frailty Risk on Adverse Outcomes after Traumatic Brain Injury: A Historical Cohort Study

Yamamoto

Hori

Ushida

et al. 2022

JCM

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We evaluated the utility of the Hospital Frailty Risk Score (HFRS) as a predictor of adverse events after hospitalization in a retrospective analysis of traumatic brain injury (TBI). This historical cohort study analyzed the data of patients hospitalized with TBI between April 2014 and August 2020 who were registered in the JMDC database. We used HFRS to classify the patients into the low- (HFRS < 5), intermediate- (HFRS5-15), and high- (HFRS > 15)-frailty risk groups. Outcomes were the length of hospital stay, the number of patients with Barthel Index score ≥ 95 on, Barthel Index gain, and in-hospital death. We used logistic and linear regression analyses to estimate the association between HFRS and outcome in TBI. We included 18,065 patients with TBI (mean age: 71.8 years). Among these patients, 10,139 (56.1%) were in the low-frailty risk group, 7388 (40.9%) were in the intermediate-frailty risk group, and 538 (3.0%) were in the high-frailty risk group. The intermediate- and high-frailty risk groups were characterized by longer hospital stays than the low-frailty risk group (intermediate-frailty risk group: coefficient 1.952, 95%; confidence interval (CI): 1.117–2.786; high-frailty risk group: coefficient 5.770; 95% CI: 3.160–8.379). The intermediate- and high-frailty risk groups were negatively associated with a Barthel Index score ≥ 95 on discharge (intermediate-frailty risk group: odds ratio 0.645; 95% CI: 0.595–0.699; high-frailty risk group: odds ratio 0.221; 95% CI: 0.157–0.311) and Barthel Index gain (intermediate-frailty risk group: coefficient −4.868, 95% CI: −5.599–−3.773; high-frailty risk group: coefficient −19.596, 95% CI: −22.242–−16.714). The intermediate- and high-frailty risk groups were not associated with in-hospital deaths (intermediate-frailty risk group: odds ratio 0.901; 95% CI: 0.766–1.061; high-frailty risk group: odds ratio 0.707; 95% CI: 0.459–1.091). We found that HFRS could predict adverse outcomes during hospitalization in TBI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Frailty Risk on Adverse Outcomes after Traumatic Brain Injury: A Historical Cohort Study

Yamamoto

Hori

Ushida

et al. 2022

JCM

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“…Marengoni et al 9 found that the pooled prevalence of frailty in individuals with COPD was 19% and patients with COPD had two-fold increased risk of frailty comparing those without COPD. Previous studies indicated that frailty appears to have a negative impact upon clinical outcomes related to function and health [10][11][12][13] ,but the real clinical impact has not yet been explicitly quanti ed. In this study, therefore, we aim to conduct a systematic review with meta-analysis to quantify the impacts of frailty upon health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical impact of frailty in COPD：A Systematic Review and Meta-analysis

Wang

Zhang

Liu

2023

Preprint

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Background: Frailty has been increasingly identified as a risk factor of adverse outcomes in chronic obstructive pulmonary disease (COPD). The prevalence and impact of frailty on health outcomes in people with COPD require clarification. Methods: PubMed, Embase, The Cochrane Library and Web of Science (January 1, 2002, to July 1, 2022) were comprehensively searched to identify studies related to frailty and COPD. Comparisons were made between people who did and did not have frailty for pulmonary function, dyspnea severity, 6-minute walking distance, activities of daily life, and mortality. Results: Twenty studies (8 cross-sectional, 6 prospective, 5 retrospective cohort,1 clinical trial) from Europe (9), Asia (6), and North and South America (4), Oceania (1) involving 11, 620 participants were included. The prevalence of frailty ranged from 6.43% to 71.7% based on the frailty tool used. Overall sarcopenia prevalence varied from 32.07% (95% confidence interval (CI) 26.64–37.49). People with frailty had lower predicted forced expiratory volume in the first second (mean difference -5.06%; 95%CI -6.70 to -3.42%)，shorter 6-minute walking distance (mean difference -90.23 meter; 95%CI -124.70 to -55.76), poorer activities of daily life (standardized mean difference -0.99; 95%CI -1.35 to -0.62) , higher CAT score(mean difference 6.2; 95%CI 4.43 to 7.96) and mMRC grade (mean difference 0.93; 95%CI 0.85 to 1.02) compared with those who did not (P < 0.001 for all). Meta-analysis showed that frailty was associated with an increased risk of long-term all-cause mortality (HR 1.68; 95% CI 1.37-2.05; I2=0%, p < 0.00, Tau-squared=0). Conclusion: Frailty is prevalent in people with COPD and associates with negative clinical outcomes including pulmonary function, dyspnea severity, exercise capacity, quality of life and mortality.

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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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Hospital Frailty Risk Score Predicts Outcomes in Chronic Obstructive Pulmonary Disease Exacerbations

Cited by 22 publications

References 25 publications

Impact of Frailty Risk on Adverse Outcomes after Traumatic Brain Injury: A Historical Cohort Study

Impact of Frailty Risk on Adverse Outcomes after Traumatic Brain Injury: A Historical Cohort Study

Prevalence and clinical impact of frailty in COPD：A Systematic Review and Meta-analysis

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

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