Department of Health Policy, London School of Economics and Political Science, London, UK.
Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain.
Lancet Healthy Longev. 2021 Mar;2(3):e154-e162. doi: 10.1016/S2666-7568(21)00004-0.
The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission.
This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission.
Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and -1% (-1·2 to -0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power.
We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions.
National Institute of Health Research.
医院衰弱风险评分（HFRS）已被广泛应用于发表的研究中，但应用方式并不一致，特别是在构建评分时如何使用之前住院记录的诊断信息。我们旨在评估在构建 HFRS 时应考虑多少次既往住院，并评估衰弱风险对住院时间延长、院内死亡和 30 天再入院的影响。
这是一项回顾性观察性队列研究，纳入了年龄在 75 岁及以上、至少有一次在英国英格兰约克郡和亨伯地区 49 家医院急诊入院的患者。我们为每位患者构建了多个版本的 HFRS，每个版本均采用了 1 年或 2 年窗口内之前更多次住院的诊断数据。我们评估了每个 HFRS 版本预测住院时间延长（>10 天）、院内死亡和 30 天再入院的能力。
2013 年 4 月 1 日至 2017 年 3 月 31 日期间，282091 名患者共有 675155 次住院。评估 HFRS 不同构建形式的回归分析表明，在之前 2 年内当前和前两次住院记录的诊断信息构建的 HFRS 形式最适合预测所有三种结局。根据这种构建方式，674615 次患者住院中 263432 次（39.0%）被归类为衰弱风险低，其中 33333 次（12.7%）住院时间延长，10145 次（3.9%）院内死亡，45226 次（17.2%）在 30 天内再入院。与衰弱风险低的患者相比，衰弱风险中等的患者住院时间延长的可能性高 2.5 倍（95%CI 2.4 至 2.6），院内死亡的可能性高 2.17 倍（2.1 至 2.2），再入院的可能性高 0.7%（0.5 至 1）。衰弱风险高的患者住院时间延长的可能性高 4.3 倍（4.2 至 4.5），院内死亡的可能性高 2.48 倍（2.4 至 2.6），再入院的可能性低 1%（-1.2 至 -0.5）。衰弱风险的中危和高危类别比我们分析中纳入的其他丰富的一组对照变量更能预测住院时间延长。这些类别也被证明是院内死亡率的重要预测因素，只有 Charlson 合并症指数的预测能力更强。
我们建议使用当前入院和之前 2 年内的两次入院记录构建 HFRS。这种 HFRS 形式是住院时间延长和院内死亡的有力预测指标，但对急诊再入院的预测作用较小。
英国国家卫生研究院。
