S1276 Frailty Is Associated With Worse Outcomes in Patients Hospitalized With Non-Alcoholic Steatohepatitis (NASH)

Abstract

Introduction: Frailty is an important predictor of morbidity and mortality in hospitalized patients. Concurrently, nonalcoholic steatohepatitis (NASH) is the most rapidly growing etiology for liver failure-related hospitalization and use of hospital resources. The Hospital Frailty Risk Score (HFRS) is a validated algorithmic score using International Classification of Diseases codes (ICD-10) for identification of frailty in hospitalized patients. We aimed to study the role of HFRS as a predictor of outcomes and healthcare resource utilization in patients with NASH. Methods: We performed a retrospective cohort study of hospitalized patients in the National Inpatient Sample (NIS) 2017 to 2019, with a primary discharge diagnosis of NASH. Based on HFRS, we classified patients into 2 groups: NASH with frailty (NASH+frailty, HFRS ≥5) or NASH without frailty (NASH-frail, HFRS < 5). Our primary outcomes were all-cause in-hospital mortality and hospitalization cost. Secondary outcomes included hospital complications and ICU admissions. We performed multivariable logistic regression for outcomes, and discharge-level weights were applied to provide national estimates. Results: 13,830 hospitalizations met inclusion criteria, of which 49.1% (6,790) were identified as NASH+frailty and 50.9% (7,040) as NASH-frailty. After adjusting for age, gender, race, hospital location and teaching status, insurance, median household income and Charlson Comorbidity Index, patients with NASH+frailty were at higher risk for all-cause inpatient mortality [OR: 4.66, 95% CI (2.70 – 8.05); p< 0.001] and organ-specific complications: cardiac [OR: 1.32, 95% CI (1.08 – 1.61); p=0.006], pulmonary [OR: 1.66, 95% CI (1.35 – 2.04); p< 0.001], and infectious [OR: 12.47, 95% CI (9.01 – 17.08); p< 0.001]. NASH+frailty was associated with higher odds of requiring intensive care [OR: 4.24, 95% CI (2.86 – 6.28); p< 0.001] and had longer length of stay [9.5 days versus 4.4 days (p< 0.001)] along with higher total charges [Difference: $70,087, 95% CI (59,882 – 89,292); p< 0.001] when compared to NASH-frailty (Table). Conclusion: Frailty was independently associated with worse outcomes and higher health care utilization in patients with NASH, even after adjustment for age and comorbidity. NASH patients with frailty might benefit from more aggressive approach during hospitalization to prevent adverse outcomes. Table 1. - Baseline characteristics and outcomes of the frail NASH and non-frail NASH group Variable NASH without Frailty n=7,040 NASH with Frailty* n= 6,790 p-value Female, % 59.80 64.58 0.011 Age (years), mean ± SD 62.16 ± 12.10 64.61 ± 11.10 < 0.001 Age >=65 years, % 46.45 52.80 < 0.001 Charlson Comorbidity Index, mean ± SD 3.89 ± 2.15 5.23 ± 2.30 < 0.001 Hospital Frailty Risk Score, mean ± SD 2.36 ± 1.54 8.51 ± 2.98 < 0.001 In-hospital all-cause mortality, % 1.35 6.19 < 0.001 Length of Stay (days), mean ± SD 4.47 ± 5.32 9.5 ± 11.65 < 0.001 Total Charges ($), mean ± SD 68,086 ± 185,054 141,708 ± 288,832 < 0.001 Cardiac complications, % 17.83 29.31 < 0.001 Pulmonary complications, % 17.47 27.76 < 0.001 Gastrointestinal complications, % 7.81 15.61 < 0.001 Infectious complications, % 3.76 29.23 < 0.001 Vasopressor use, % 0.71 3.02 < 0.001 Required intensive care unit care, % 2.63 9.79 < 0.001 Multivariate Regression Outcomes# Outcome Adjusted Odds Ratio (NASH+frailty vs non-frail) 95% CI p-value In-hospital mortality 4.66 [2.70 – 8.05] < 0.001 Length of stay (Days) 4.75& [3.72 – 5.58] < 0.001 Total charges ($) 70,087& [50,882.42 – 89,292.91] < 0.001 Cardiac complications 1.32 [1.08 – 1.61] 0.006 Pulmonary complications 1.66 [1.35 – 2.04] < 0.001 Gastrointestinal complications 2.31 [1.75 – 3.04] < 0.001 Infectious complications 12.47 [9.10 – 17.08] < 0.001 Vasopressor use 4.74 [2.12 – 10.63] < 0.001 Required intensive care unit care 4.24 [2.86 – 6.28] < 0.001 *Frail =Hospital Frailty Risk Score (HFRS)≥5.#Analysis adjusted for age, gender, race, hospital location and teaching status, insurance, median household income and Charlson co-morbidity index.&Adjusted co-efficient representing the average difference in this outcome between NASH+frailty and NASH-frailty.