What is the clinical evidence from this study?

Study design: Observational. Population: Critical illness requiring mechanical ventilation (n=649330). Intervention: High-risk Hospital Frailty Risk Score (HFRS > 15) vs. Low-risk Hospital Frailty Risk Score (HFRS < 5). Primary outcome: In-hospital mortality (aOR 0.46, 95% CI 0.45-0.48, p=<0.001).

What question did this study set out to answer?

This research aims to externally validate the Hospital Frailty Risk Score (HFRS) in predicting patient outcomes among older adults receiving mechanical ventilation.

August 26, 2022Scientific ReportsOpen Access

External validation of the hospital frailty risk score among older adults receiving mechanical ventilation

Q: What are the key findings of this study?

Among older adults receiving mechanical ventilation, a high-risk Hospital Frailty Risk Score was paradoxically associated with a reduced risk of in-hospital mortality (aOR 0.46) compared to a low-risk score.

Q: What question did this study set out to answer?

This research aims to externally validate the Hospital Frailty Risk Score (HFRS) in predicting patient outcomes among older adults receiving mechanical ventilation.

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Key result

Among older adults receiving mechanical ventilation, a high-risk Hospital Frailty Risk Score was paradoxically associated with a reduced risk of in-hospital mortality (aOR 0.46) compared to a low-risk score.

Why the study?

The study was conducted to externally validate the Hospital Frailty Risk Score in critically ill older patients receiving mechanical ventilation.

Does the Hospital Frailty Risk Score predict in-hospital mortality, prolonged hospitalization, and 30-day readmissions in critically ill older adults receiving mechanical ventilation?

Population

649,330 weighted hospitalizations of older adults aged 75 years or older receiving mechanical ventilation

Comparison

Intermediate-risk and high-risk vs low-risk Hospital Frailty Risk Score

Design

Retrospective database cohort study

Follow-up

30-day readmissions

Authors

ESEric SySaskatchewan Health SKSandy KassirUniversity of Regina JMJonathan MailmanIsland Health

Discussion

Member takes

Implication

The Hospital Frailty Risk Score should not guide mortality prediction in ventilated older adults; leaves open its utility for other outcomes and requires population-specific validation.

Key Points

This research aims to externally validate the Hospital Frailty Risk Score (HFRS) in predicting patient outcomes among older adults receiving mechanical ventilation.
Analyzed older adult hospitalizations (≥ 75 years) from the Nationwide Readmissions Database (2016-2018) receiving mechanical ventilation.
Subcategorized frailty risk into low, intermediate, and high categories based on HFRS scores.
Used multivariable logistic regression for outcome prediction (in-hospital mortality, prolonged hospitalization, 30-day readmissions).
High-risk hospitalizations associated with increased prolonged hospitalization (aOR 5.59 [95% CI 5.24-5.97]).
High-risk hospitalizations associated with increased 30-day readmissions (aOR 1.20 [95% CI 1.13-1.27]).
High-risk hospitalizations inversely associated with in-hospital mortality (aOR 0.46 [95% CI 0.45-0.48]).

Study Design

Type

Observational (n=649,330)

Multicenter

Yes

Structured PICO

Does the Hospital Frailty Risk Score predict in-hospital mortality, prolonged hospitalization, and 30-day readmissions in critically ill older adults receiving mechanical ventilation?

Population

649,330 weighted hospitalizations of older adults aged 75 years and older receiving mechanical ventilation in the United States, evaluated for the predictive validity of the Hospital Frailty Risk Score.

Exposure

High-risk frailty (Hospital Frailty Risk Score > 15) and intermediate-risk frailty (score 5-15)

Comparator

Low-risk frailty (Hospital Frailty Risk Score < 5)

Outcome

In-hospital mortality, prolonged hospitalization, and 30-day readmissionshard clinical

Main Result

Odds Ratio: 0.46 (95% CI 0.45–0.48)

Absolute Event Rate: 38.6% vs 46.4%

p-value: p=<0.001

The Hospital Frailty Risk Score fails to accurately predict in-hospital mortality in critically ill older adults receiving mechanical ventilation and should be avoided in this population.

Limitations

Selection bias may have occurred by limiting the population to mechanically ventilated patients, who are at higher baseline risk of death.
Coding biases may occur as critically ill patients who survive or have prolonged hospitalizations may accrue more ICD-10-CM secondary diagnoses.
The database lacks sufficient information to determine ICU severity of illness (e.g., SOFA or APACHE II scores).
The database does not capture detailed clinical information such as patient weight or vasopressor dosing.
The database does not record out-of-hospital deaths, limiting the evaluation to in-hospital mortality only.

Cite This Study

Sy et al. (2022) conducted an observational in Critical illness requiring mechanical ventilation (n=649,330). High-risk Hospital Frailty Risk Score (HFRS > 15) vs. Low-risk Hospital Frailty Risk Score (HFRS < 5) was evaluated on In-hospital mortality (aOR 0.46, 95% CI 0.45-0.48, p=<0.001). Among older adults receiving mechanical ventilation, a high-risk Hospital Frailty Risk Score was paradoxically associated with a reduced risk of in-hospital mortality (aOR 0.46) compared to a low-risk score.

synapsesocial.com/papers/6a63562f809dd4a9e2c1d240 https://doi.org/10.1038/s41598-022-18970-7

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Implication

The Hospital Frailty Risk Score should not guide mortality prediction in ventilated older adults; leaves open its utility for other outcomes and requires population-specific validation.

External validation of the hospital frailty risk score among older adults receiving mechanical ventilation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

External validation of the hospital frailty risk score among older adults receiving mechanical ventilation

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider