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Association between Frailty Assessed Using Two Electronic Medical Record-Based Frailty Assessment Tools and Long-Term Adverse Prognosis in Older Critically Ill Survivors

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Frailty has become an independent risk factor for adverse outcomes in critically ill patients. This study aimed to explore the predictive ability of two electronic medical record-based frailty assessment tools, the Hospital Frailty Risk Score (HFRS) and Frailty Index based on physiological and laboratory tests (FI-lab), for long-term adverse prognosis in older critically ill survivors.

Design

Retrospective observational study.

Setting and Participants

9,082 critically ill survivors aged ≥ 65 years.

Measurements

The HFRS and the 33-item FI-lab were constructed based on the published literature. Cox and logistic regression models assessed the association between frailty and 1-year mortality and post-discharge care needs.

Results

2,586 patients died within 1 year of follow-up. In fully adjusted models, frailty assessed using both the HFRS (per point, hazard ratio [HR] 1.06, 95% confidential interval [CI] 1.05–1.06; intermediate frailty risk, HR 2.00, 95% CI 1.78–2.25; high frailty risk, HR 3.06, 95% CI 2.68–3.50) and FI-lab (per 0.01 points, HR 1.03, 95% CI 1.03–1.03; intermediate frailty risk, HR 1.59, 95% CI 1.44–1.76; high frailty risk, HR 2.30, 95% CI 2.06–2.57) was associated with mortality. Addition of frailty indicators improved the predictive validity of the Sequential Organ Failure Assessment score for mortality (HFRS alone Δ C-index 0.034; FI-lab alone Δ C-index 0.016; HFRS and FI-lab combined Δ C-index 0.042). The HFRS but not the FI-lab was associated with higher probability of post-discharge care needs.

Conclusion

Both the HFRS and FI-lab could independently predict 1-year mortality in older critically ill survivors. Adding the HFRS to the SOFA score model improved it more than adding the FI-lab. The greatest improvement was achieved when both frailty indicators were used together. These findings suggest that electronic medical record-based frailty assessment methods can be useful tools for predicting long-term outcomes in older critically ill patients.

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Data availability statement: The MIMIC-IV database are available in PhysioNet (https://physionet.org).

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Acknowledgement: We acknowledge the Laboratory for Computational Physiology team from the Massachusetts Institute of Technology (LCP-MIT) who establish and maintain the MIMIC-IV databases.

Funding

Funding: Not available.

Author information

Author notes

  1. These authors have contributed equally to this work and share first authorship

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, China

    B. Hao, W. Gao, T. Huang, L. Lyu & J. Qin

  2. Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China

    B. Hao, W. Gao, T. Huang, L. Lyu, H. Xiao, H. Li, J. Qin, Li Sheng & Hongbin Liu

  3. Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    W. Xu

  4. Medical Rehabilitation Research Center, Shandong Institute of Advanced Technology, Chinese Academy of Sciences, Jinan, China

    D. Lyu

  5. Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China

    Hongbin Liu

Authors
  1. B. Hao
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Contributions

Author contributions: Study concept and design: H-BL, LS and B-CH. Acquisition of data: B-CH, W-HX, W-YG, JQ and T-KH. Analysis and interpretation of data: D-YL, H-NX, H-YL and LL. Drafting of the manuscript: B-CH, W-HX and W-YG. Critical revision of the manuscript for important intellectual content: H-BL, LS, B-CH, W-HX, W-YG, T-KH, LL, D-YL, H-NX, H-YL and JQ.

Corresponding authors

Correspondence to Li Sheng or Hongbin Liu.

Ethics declarations

Conflicts of interest: The authors declare that they have no Conflicts of interest.

Ethics approval and consent to participate: The establishment of this de-identified database was approved by the Institutional Review Board at the Beth Israel Deaconess Medical Center. Written informed consent for participation was not required for this project in accordance with the national legislation and the institutional requirements.

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12603_2023_1961_MOESM1_ESM.docx

Association between frailty assessed using two electronic medical record-based frailty assessment tools and long-term adverse prognosis in older critically ill survivor

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Hao, B., Xu, W., Gao, W. et al. Association between Frailty Assessed Using Two Electronic Medical Record-Based Frailty Assessment Tools and Long-Term Adverse Prognosis in Older Critically Ill Survivors. J Nutr Health Aging 27, 649–655 (2023). https://doi.org/10.1007/s12603-023-1961-6

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  • DOI: https://doi.org/10.1007/s12603-023-1961-6

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