Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.

Hdl Handle:
http://hdl.handle.net/10147/559135
Title:
Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.
Authors:
Tapper, Elliot B; Finkelstein, Daniel; Mittleman, Murray A; Piatkowski, Gail; Lai, Michelle
Citation:
Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. 2015: Hepatology
Publisher:
Irish Medical Journal (IMJ)
Journal:
Hepatology (Baltimore, Md.)
Issue Date:
4-Apr-2015
URI:
http://hdl.handle.net/10147/559135
DOI:
10.1002/hep.27830
PubMed ID:
25846824
Abstract:
The risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission, and length of stay. Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale, and the Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts: 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6%, and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, Model for End-Stage Liver Disease, sodium, and Charlson index, the odds ratio for the effect of an ADL score of less than 12 of 15 on mortality is 1.83 (95% confidence interval [CI] 1.05-3.20). A predictive model for 90-day mortality including ADL and Braden Scale yielded C statistics of 0.83 (95% CI 0.80-0.86) and 0.77 (95% CI 0.71-0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and Braden Scale (<16), with respective adjusted odds ratios of 3.78 (95% CI 1.97-7.29) and 6.23 (95% CI 2.53-15.4). Length of stay was associated with the Braden Scale (<16) (hazard ratio = 0.63, 95% CI 0.44-0.91). No frailty measure was associated with 30-day readmission.
Item Type:
Article
Language:
en
Keywords:
LIVER DISEASE; INPATIENTS; MORBIDITY; MORTALITY
ISSN:
1527-3350

Full metadata record

DC FieldValue Language
dc.contributor.authorTapper, Elliot Ben
dc.contributor.authorFinkelstein, Danielen
dc.contributor.authorMittleman, Murray Aen
dc.contributor.authorPiatkowski, Gailen
dc.contributor.authorLai, Michelleen
dc.date.accessioned2015-07-07T10:49:16Zen
dc.date.available2015-07-07T10:49:16Zen
dc.date.issued2015-04-04en
dc.identifier.citationStandard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. 2015: Hepatologyen
dc.identifier.issn1527-3350en
dc.identifier.pmid25846824en
dc.identifier.doi10.1002/hep.27830en
dc.identifier.urihttp://hdl.handle.net/10147/559135en
dc.description.abstractThe risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission, and length of stay. Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale, and the Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts: 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6%, and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, Model for End-Stage Liver Disease, sodium, and Charlson index, the odds ratio for the effect of an ADL score of less than 12 of 15 on mortality is 1.83 (95% confidence interval [CI] 1.05-3.20). A predictive model for 90-day mortality including ADL and Braden Scale yielded C statistics of 0.83 (95% CI 0.80-0.86) and 0.77 (95% CI 0.71-0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and Braden Scale (<16), with respective adjusted odds ratios of 3.78 (95% CI 1.97-7.29) and 6.23 (95% CI 2.53-15.4). Length of stay was associated with the Braden Scale (<16) (hazard ratio = 0.63, 95% CI 0.44-0.91). No frailty measure was associated with 30-day readmission.en
dc.languageENGen
dc.language.isoenen
dc.publisherIrish Medical Journal (IMJ)en
dc.rightsArchived with thanks to Hepatology (Baltimore, Md.)en
dc.subjectLIVER DISEASEen
dc.subjectINPATIENTSen
dc.subjectMORBIDITYen
dc.subjectMORTALITYen
dc.titleStandard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.en
dc.typeArticleen
dc.identifier.journalHepatology (Baltimore, Md.)en
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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