C0499 - Frailty Is Associated With Worse Outcomes in Patients Hospitalized With Non-Alcoholic Steatohepatitis (NASH)

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmad Nawaz, MD

Yale University School of Medicine
New Haven, CT

Ahmad Nawaz, MD, Rabia Rizwan, MD, Abdelkader Chaar, MD, Albert Do, MD, MPH
Yale University School of Medicine, New Haven, CT

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 1).

Discussion: 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.

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

Table: Baseline characteristics and outcomes of the frail NASH and non-frail NASH group

Disclosures:

Ahmad Nawaz indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Abdelkader Chaar indicated no relevant financial relationships.

Albert Do indicated no relevant financial relationships.

Ahmad Nawaz, MD, Rabia Rizwan, MD, Abdelkader Chaar, MD, Albert Do, MD, MPH. C0499 - Frailty Is Associated With Worse Outcomes in Patients Hospitalized With Non-Alcoholic Steatohepatitis (NASH), ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.