Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, 1468 Madison Ave, Annenberg RM 5-12, New York, NY, 100329, USA.
Departments of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Dig Dis Sci. 2021 Dec;66(12):4178-4190. doi: 10.1007/s10620-020-06746-w. Epub 2021 Jan 1.
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.
尽管年龄通常被用作临床风险分层工具，但最近的数据表明，不良结局是由虚弱而不是实际年龄驱动的。
在这项全国性队列研究中，我们评估了虚弱的流行率，以及与住院 IBD 患者 30 天再入院和死亡相关的因素。
我们使用全国再入院数据库，检查了 2010 年至 2014 年期间所有住院的 IBD 患者。根据索引入院，我们使用先前验证过的 ICD 代码定义了 IBD 和虚弱。我们使用单变量和多变量回归来评估与全因 30 天再入院和 30 天再入院死亡率相关的危险因素。
2010 年至 2014 年期间，共确定了 1405529 例 IBD 索引入院，其中 152974 例（10.9%）被归类为虚弱。在此期间，虚弱的患病率逐年增加，从 2010 年的 10.20%（27594 例）增加到 2014 年的 11.45%（33507 例）。在多变量分析中，虚弱是再入院的独立预测因素（ARR 1.16，95%CI：1.14-1.17），以及调整相关临床因素后再入院死亡率的独立预测因素（ARR 1.12，95%CI 1.02-1.23）。在按 IBD 亚型、入院特征（手术与非手术）、年龄（患者≥60 岁）分层后，以及在排除营养不良、体重减轻和粪便失禁作为虚弱指标后，虚弱仍然与再入院相关。相反，我们发现年龄较大与再入院风险较低相关。
虚弱独立于年龄、合并症和入院严重程度，与 IBD 患者再入院和死亡风险增加相关，且其患病率呈上升趋势。鉴于虚弱是一个潜在可改变的危险因素，需要对 IBD 患者人群进行前瞻性评估虚弱的未来研究。
