Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation

• Published in: Journal of critical care Vol. 44; pp. 212 - 216
• Main Authors: Hope, Aluko A., Adeoye, Oriade, Chuang, Elizabeth H., Hsieh, S.J., Gershengorn, Hayley B., Gong, Michelle N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018; Elsevier Limited
• Subjects: Acute respiratory failure; Adults; Aged; Aged, 80 and over; Alzheimer's disease; Anesthesia; Cohort Studies; Comorbidity; Data warehouses; Fecal incontinence; Female; Frailty; Geriatric Assessment; Health Services for the Aged; Hospital costs; Hospital length-of-stay; Hospital Mortality; Hospitalization; Humans; Illnesses; Intensive care; Laboratories; Length of Stay; Malnutrition; Middle Aged; Mortality; Multiple organ dysfunction syndrome; New York City; Palliative care; Patients; Respiration, Artificial; Respiratory distress syndrome; Respiratory failure; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Retrospective Studies; Survival Analysis; Systematic review; Validity; Ventilators; New York City; New York; United States > US; SOFA; Hospital mortality; pLOS; Hospital length-of-stay; aOR; ARF; Frailty; Acute respiratory failure; ICU; PHF
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.11.017

We aimed to estimate the independent effect of pre-hospital frailty (PHF) on hospital mortality and prolonged hospital length of stay (pLOS) while adjusting for other patient level factors. This is a cohort study of hospitalized adults with acute respiratory failure (ARF) who required invasive mechanical ventilation for ≥24h in 2013. We used inpatient/outpatient claims from a list of diagnoses from the year before index hospital admission to define PHF. Differences in characteristics/outcomes by PHF were explored using descriptive statistics; multivariable logistic regression was used to estimate association between PHF and hospital outcomes. Among 1157 patients (mean age (standard deviation) 67.1 [16.4]), 53.2% had PHF. PHF was independently associated with higher hospital mortality (44.2% in PHF patients vs. 34.6% in those without, adjusted Odds Ratio (aOR) (95% Confidence Interval [CI] 1.56 (1.19–2.05), p<0.001). PHF was also significantly associated with pLOS in hospital survivors (55.5% PHF patients had pLOS versus 34.2% in those without, aOR (95% CI) 2.61 (1.87–3.65), p<0.001). PHF, identified by frailty diagnoses from before index hospitalization, may be a useful approach for identifying adults with ARF at increased risk of hospital mortality and pLOS. •Acute respiratory failure is the most common acute organ dysfunction in US hospitals, associated with a high risk of morbidity and mortality.•Pre-hospital frailty, a syndrome of age or disease-related decline in physiologic reserve, has been associated with adverse outcomes in acutely ill elderly adults but has not been explored in adults with acute respiratory failure.•In a cohort of 1157 adults with acute respiratory failure, we found that about 53% had diagnoses in the year prior to the index hospitalization consistent with pre-hospital frailty.•Pre-hospital frailty was associated with 1.5x the odds of dying in the hospital and more than 2.5x the odds of surviving after a prolonged hospital length-of-stay.•Our findings suggest that health systems may be able to use a diagnosis-based approach to systematically risk stratify patients with acute respiratory failure.