A0086 - Frailty Is a Predictor for Worse Outcomes in Patients Hospitalized With Clostridioides difficile Infection

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Abdelkader Chaar, MD

Yale University School of Medicine
New Haven, CT

Abdelkader Chaar, MD¹, Ahmad Nawaz, MD¹, Rabia Rizwan, MD¹, Osama Qasim Agha, MD², Paul Feuerstadt, MD, FACG³
¹Yale University School of Medicine, New Haven, CT; ²Creighton University/St. Joseph Medical Center, Phoenix, AZ; ³PACT Gastroenterology Center and Yale University School of Medicine, New Haven, CT

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 1).

Discussion: 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.

Variable	NonFrailCDI n=39,510	FrailCDI n= 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

Table: Table 1: Baseline characteristics and outcomes.
* 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

Disclosures:

Abdelkader Chaar indicated no relevant financial relationships.

Ahmad Nawaz indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Osama Qasim Agha indicated no relevant financial relationships.

Paul Feuerstadt: Ferring/Rebiotix Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speakers Bureau. Merck and Co – Consultant. Seres Therapeutics – Advisory Committee/Board Member, Consultant. Takeda Pharmaceuticals – Advisory Committee/Board Member.

Abdelkader Chaar, MD¹, Ahmad Nawaz, MD¹, Rabia Rizwan, MD¹, Osama Qasim Agha, MD², Paul Feuerstadt, MD, FACG³. A0086 - Frailty Is a Predictor for Worse Outcomes in Patients Hospitalized With Clostridioides difficile Infection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.