Increasing Prevalence of Frailty and Its Association with Readmission and Mortality Among Hospitalized Patients with IBD.
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Comorbidity
Databases, Factual
Female
Frail Elderly
Frailty
/ diagnosis
Humans
Inflammatory Bowel Diseases
/ diagnosis
Inpatients
Male
Middle Aged
Patient Readmission
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
United States
/ epidemiology
Young Adult
Frailty
IBD
Mortality
Readmissions
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
03
10
2020
accepted:
23
11
2020
pubmed:
2
1
2021
medline:
15
12
2021
entrez:
1
1
2021
Statut:
ppublish
Résumé
Although age is often used as a clinical risk stratification tool, recent data have suggested that adverse outcomes are driven by frailty rather than chronological age. In this nationwide cohort study, we assessed the prevalence of frailty, and factors associated with 30-day readmission and mortality among hospitalized IBD patients. Using the Nationwide Readmission Database, we examined all patients with IBD hospitalized from 2010 to 2014. Based on index admission, we defined IBD and frailty using previously validated ICD codes. We used univariable and multivariable regression to assess risk factors associated with all-cause 30-day readmission and 30-day readmission mortality. From 2010 to 2014, 1,405,529 IBD index admissions were identified, with 152,974 (10.9%) categorized as frail. Over this time period, the prevalence of frailty increased each year from 10.20% (27,594) in 2010 to 11.45% (33,507) in 2014. On multivariable analysis, frailty was an independent predictor of readmission (aRR 1.16, 95% CI: 1.14-1.17), as well as readmission mortality (aRR 1.12, 95% CI 1.02-1.23) after adjusting for relevant clinical factors. Frailty also remained associated with readmission after stratification by IBD subtype, admission characteristics (surgical vs. non-surgical), age (patients ≥ 60 years old), and when excluding malnutrition, weight loss, and fecal incontinence as frailty indicators. Conversely, we found older age to be associated with a lower risk of readmission. Frailty, independent of age, comorbidities, and severity of admission, is associated with a higher risk of readmission and mortality among IBD patients, and is increasing in prevalence. Given frailty is a potentially modifiable risk factor, future studies prospectively assessing frailty within the IBD patient population are needed.
Sections du résumé
BACKGROUND
Although age is often used as a clinical risk stratification tool, recent data have suggested that adverse outcomes are driven by frailty rather than chronological age.
AIMS
In this nationwide cohort study, we assessed the prevalence of frailty, and factors associated with 30-day readmission and mortality among hospitalized IBD patients.
METHODS
Using the Nationwide Readmission Database, we examined all patients with IBD hospitalized from 2010 to 2014. Based on index admission, we defined IBD and frailty using previously validated ICD codes. We used univariable and multivariable regression to assess risk factors associated with all-cause 30-day readmission and 30-day readmission mortality.
RESULTS
From 2010 to 2014, 1,405,529 IBD index admissions were identified, with 152,974 (10.9%) categorized as frail. Over this time period, the prevalence of frailty increased each year from 10.20% (27,594) in 2010 to 11.45% (33,507) in 2014. On multivariable analysis, frailty was an independent predictor of readmission (aRR 1.16, 95% CI: 1.14-1.17), as well as readmission mortality (aRR 1.12, 95% CI 1.02-1.23) after adjusting for relevant clinical factors. Frailty also remained associated with readmission after stratification by IBD subtype, admission characteristics (surgical vs. non-surgical), age (patients ≥ 60 years old), and when excluding malnutrition, weight loss, and fecal incontinence as frailty indicators. Conversely, we found older age to be associated with a lower risk of readmission.
CONCLUSIONS
Frailty, independent of age, comorbidities, and severity of admission, is associated with a higher risk of readmission and mortality among IBD patients, and is increasing in prevalence. Given frailty is a potentially modifiable risk factor, future studies prospectively assessing frailty within the IBD patient population are needed.
Identifiants
pubmed: 33385264
doi: 10.1007/s10620-020-06746-w
pii: 10.1007/s10620-020-06746-w
pmc: PMC8493658
mid: NIHMS1743965
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4178-4190Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001854
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK083256
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK111995
Pays : United States
Organisme : NIDDK NIH HHS
ID : R03 DK112909
Pays : United States
Organisme : NINDS NIH HHS
ID : L40 NS108316
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. Springer Science+Business Media, LLC, part of Springer Nature.
Références
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2054-2063.e14
pubmed: 32801013
Clin Gastroenterol Hepatol. 2016 Sep;14(9):1274-81
pubmed: 26656299
Gastroenterol Hepatol (N Y). 2016 Nov;12(11):704-707
pubmed: 28035199
BMC Med. 2016 Dec 22;14(1):215
pubmed: 28003033
Am J Manag Care. 2012 Oct 01;18(10):e392-7
pubmed: 23145847
N Engl J Med. 2009 Nov 19;361(21):2066-78
pubmed: 19923578
J Appl Gerontol. 2021 Jan;40(1):38-46
pubmed: 31849257
J Crohns Colitis. 2015 Jun;9(6):507-15
pubmed: 25870198
J Crohns Colitis. 2014 Dec;8(12):1661-7
pubmed: 25107847
Gut. 2014 Mar;63(3):423-32
pubmed: 23408350
Gastroenterology. 2020 Jun;158(8):2041-2043
pubmed: 32247690
J Can Assoc Gastroenterol. 2019 Feb;2(Suppl 1):S68-S72
pubmed: 31294386
Inflamm Bowel Dis. 2013 Feb;19(2):309-15
pubmed: 22605668
BMJ. 2018 Feb 27;360:k497
pubmed: 29487063
Inflamm Bowel Dis. 2017 Jun;23(6):875-881
pubmed: 28426473
JAMA Cardiol. 2019 Nov 1;4(11):1084-1091
pubmed: 31553402
HIV Med. 2017 Nov;18(10):764-771
pubmed: 28737297
Aliment Pharmacol Ther. 2015 Aug;42(4):441-51
pubmed: 26104047
JAMA Netw Open. 2019 Aug 2;2(8):e198398
pubmed: 31373653
BMJ Open. 2015 Sep 07;5(9):e008597
pubmed: 26346875
J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63
pubmed: 15031310
Inflamm Bowel Dis. 2017 Jun;23(6):882-893
pubmed: 28375885
Cochrane Database Syst Rev. 2013 Feb 28;(2):CD004294
pubmed: 23450551
Clin Gastroenterol Hepatol. 2020 May;18(5):1133-1141.e3
pubmed: 31336196
Lancet. 2019 Oct 12;394(10206):1365-1375
pubmed: 31609228
MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):377-381
pubmed: 28406887
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Ann Thorac Surg. 2020 Apr;109(4):1120-1126
pubmed: 32200907
Chest. 2018 Jul;154(1):21-40
pubmed: 29477493
Gastroenterology. 2020 Jun;158(8):2104-2111.e2
pubmed: 32105728
World J Gastroenterol. 2017 Feb 7;23(5):899-905
pubmed: 28223735
Ann Intern Med. 2017 Nov 21;167(10):706-713
pubmed: 29049488
Aliment Pharmacol Ther. 2020 Jul;52(2):311-318
pubmed: 32537744
Lancet. 2018 Dec 23;390(10114):2769-2778
pubmed: 29050646
Am J Manag Care. 2019 Oct;25(10):474-481
pubmed: 31622063
Aliment Pharmacol Ther. 2020 May;51(9):820-830
pubmed: 32170782
Urology. 2019 Nov;133:25-33
pubmed: 31306670
Laryngoscope. 2020 Feb;130(2):290-296
pubmed: 30983004
Mayo Clin Proc. 2019 Jan;94(1):155-165
pubmed: 30611442