Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.
Hepatology. 2015 Apr 4;
Authors: Tapper EB, Finkelstein D, Mittleman MA, Piatkowski G, Lai M
The risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission and length of stay (LOS). Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale (BS), and Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts. 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6% and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, MELD, sodium and Charlson index, the odds ratio (OR) for the effect of an ADL score less than 12 of 15 on mortality is 1.83 95% CI (1.05 - 3.20). A predictive model for 90-day mortality including ADL and BS yielded an c-statistics of 0.83 95% CI (0.80 - 0.86) and 0.77 95% CI (0.71 - 0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and BS (< 16) with respective adjusted OR of 3.78 95% CI (1.97 - 7.29) and 6.23 95% CI (2.53 - 15.4). LOS was associated with the BS (< 16), hazard ratio 0.63 95% CI (0.44 - 0.91). No frailty measure associated with 30-day readmission.
CONCLUSIONS: Readily available, standardized measures of frailty predict 90 day mortality, LOS, and rehabilitation needs for hospitalized patients with cirrhosis. This article is protected by copyright. All rights reserved.
PMID: 25846824 [PubMed - as supplied by publisher]