S158 Frailty Is a Predictor for Worse Outcomes in Patients Hospitalized With Clostridioides difficile Infection

Abstract

Introduction: Frailty is recognized as a having major health implications for affected patients and is applicable in the peri-operative risk assessment. Hospital Frailty Risk Score (HFRS) is a validated score that solely utilizes International Classification of Diseases codes (ICD-10) in the identification of patients who are at higher risk. In this study, we investigated the utility of HFRS in identifying patients admitted with Clostridioides difficile infection (CDI) who are at risk for worse clinical outcomes and higher healthcare resource utilization. Methods: Using the 2017 National Inpatient Sample, we identified all adult patients who were discharged with a primary diagnosis of CDI. We then classified patients into 2 groups: those who had HFRS of ≤5 (NonFrailCDI) and those with a score of >5 (FrailCDI). Primary outcomes included all-cause in hospital mortality rates and healthcare utilization while secondary outcomes included hospital complications. Discharge-level weights were applied to provide national estimates. Results: We identified 93,810 hospitalizations with a primary discharge diagnosis of CDI, of which 54,300 (57.88%) were FrailCDI while 39,510 (42.12%) were NonFrailCDI. Using a multivariate analysis after adjusting for demographics and Charlson co-morbidity index, FrailCDI patients were at higher risk for inpatient mortality [OR: 4.49, 95% CI (2.84 – 7.11); p< 0.001], cardiac [OR: 1.13, 95% CI (1.02 – 1.25); p=0.013], pulmonary [OR: 1.92, 95% CI (1.65 – 2.22); p< 0.001], infectious [OR: 6.80, 95% CI (6.01 – 7.69); p< 0.001], and renal [OR: 8.76, 95% CI (8.08 – 9.48); p< 0.001] complications. Furthermore, FrailCDI patients had higher odds of requiring intensive care [OR: 13.70, 95% CI (6.28 – 29.90); p< 0.001] and had longer length of stay [Difference: 1.70 days, 95% CI (1.55 – 1.86); p< 0.001] along with higher total charges [Difference: 11,843.56$, 95% CI (10,366.32 – 13,320.8); p< 0.001] when compared to NonFrailCDI. (Table). Conclusion: Frailty status as defined by HFRS is an independent factor for worse outcomes and higher healthcare utilization in adult patients admitted for CDI even after adjusting for age and Charlson co-morbidity index. By considering this index in patients with CDI, we might consider more aggressive therapy to improve outcomes. Further research is needed to identify which therapeutics are most optimal in the frail population. Table 1. - Baseline characteristics and outcomes Variable NonFrailCDIn=39,510 FrailCDIn= 54,300 p-value Female, % 63.95 64.31 0.611 Age (years), mean ± SD 60.07 ± 18.63 70.53 ± 15.43 < 0.001 Age >=65 years, % 44.50 69.48 < 0.001 Charlson co-morbidity index 1.56 ± 1.92 2.77 ± 2.25 < 0.001 Hospital Frailty Risk Score, mean ± SD 2.59 ± 1.51 8.95 ± 3.27 < 0.001 In-hospital all-cause mortality, % 0.33 2.10 < 0.001 Length of Stay (Days), mean ± SD 4.24 ± 3.42 6.28 ± 6.48 < 0.001 Total Charges ($), mean ± SD 30,908.25 ± 34,174.49 44,180.51 ± 57,287.25 < 0.001 Cardiac complications, % 11.29 22.97 < 0.001 Pulmonary complications, % 3.34 8.29 < 0.001 GI complications, % 4.61 4.86 0.414 ID complications, % 4.63 26.73 < 0.001 Renal complications, % 44.55 87.27 < 0.001 Required Intensive Care Unit, % 0.10 1.30 < 0.001 Multivariate Regression for the Outcomes* Outcome Adjusted Odds Ratio(FrailCDI vs NonFrailCDI) 95% CI p-value In-hospital mortality 4.49 [2.84 – 7.11] < 0.001 Length of Stay (Days) 1.70** [1.55 – 1.86] < 0.001 Total Charges ($) 11,843.56** [10,366.32 – 13,320.8] < 0.001 Cardiac complications 1.13 [1.02 – 1.25] 0.013 Pulmonary complications 1.92 [1.65 – 2.22] < 0.001 GI complications 1.17 [1.00 – 1.36] 0.048 ID complications 6.80 [6.01 – 7.69] < 0.001 Renal complications 8.76 [8.08 – 9.48] < 0.001 Required Intensive Care Unit 13.70 [6.28 – 29.90] < 0.001 *Analysis adjusted for age, gender, race, hospital location and teaching status, insurance, median household income and Charlosn co-morbidity index.**Adjusted co-efficient representing the average difference in this outcome between FrailCDI and NonFrailCDI.