Association between Frailty Assessed Using Two Electronic Medical Record-Based Frailty Assessment Tools and Long-Term...

Area of Science:

• Gerontology and Critical Care Medicine
• Health Informatics and Predictive Analytics

Background:

• Frailty is a significant independent risk factor for adverse outcomes in critically ill patients.
• Accurate prediction of long-term prognosis is crucial for managing older critically ill survivors.

Purpose of the Study:

• To evaluate the predictive performance of two electronic medical record-based frailty assessment tools: the Hospital Frailty Risk Score (HFRS) and the Frailty Index based on physiological and laboratory tests (FI-lab).
• To assess their ability to predict long-term adverse prognosis, including 1-year mortality and post-discharge care needs, in older critically ill survivors.

Main Methods:

• Retrospective observational study involving 9,082 critically ill survivors aged 65 years and older.
• Construction of the HFRS and the 33-item FI-lab based on published literature.
• Utilized Cox and logistic regression models to analyze the association between frailty scores and 1-year mortality and post-discharge care needs.

Main Results:

• Both HFRS and FI-lab were independently associated with increased 1-year mortality in older critically ill survivors.
• The addition of frailty indicators improved the predictive validity of the Sequential Organ Failure Assessment (SOFA) score for mortality, with the combined HFRS and FI-lab yielding the greatest improvement (∆ C-index 0.042).
• The HFRS was associated with a higher probability of post-discharge care needs, whereas the FI-lab was not.

Conclusions:

• Both HFRS and FI-lab are valuable tools for independently predicting 1-year mortality in older critically ill patients.
• Incorporating the HFRS into the SOFA score model enhances mortality prediction more effectively than FI-lab alone, with combined use offering the most significant improvement.
• Electronic medical record-based frailty assessment methods, particularly the HFRS, show promise for predicting long-term outcomes in this vulnerable population.