Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Gastrointest Endosc. 2021 Sep;94(3):517-525.e11. doi: 10.1016/j.gie.2021.03.021. Epub 2021 Mar 19.
Frailty is a known predictor of mortality and adverse events in the inpatient setting; however, it has not been studied as a modality to assess risk among patients undergoing endoscopy for GI bleeding (GIB). We aimed to determine the association between frailty status and risk of adverse events in hospitalized patients with GIB who underwent endoscopy.
We performed a cohort study using the 2016 and 2017 National Inpatient Sample database, using International Classification of Diseases diagnostic codes to identify adult patients with GIB who underwent endoscopic procedures within 2 days of admission and the Hospital Frailty Risk Score to classify patients as frail or nonfrail. Univariable and multivariable logistic regression models were constructed to assess the predictors of periprocedural adverse events, and marginal standardization analysis was performed to assess for possible interaction between age and frailty.
A total of 757,920 patients met inclusion criteria, of which 44.4% (336,895) were identified as frail and 55.6% (421,025) as nonfrail; 49.2% of frail patients had composite periprocedural adverse events compared with 25.5% of nonfrail patients (P < .001). Frail patients notably had more cardiovascular (32.1% vs 17.1%, P < .001), pulmonary (18.5% vs 4.3%, P < .001), GI (10.1% vs 6.1%, P < .001), and infectious (9.9% vs .7%, P < .001) adverse events compared with nonfrail patients. Frail patients also had higher all-cause inpatient mortality rates (4.8% vs .5%, P < .001). On multivariable analysis, positive frailty status was associated with a 2.13 times increased likelihood of having composite periprocedural adverse events.
In hospitalized patients undergoing endoscopy for GIB, frailty status is associated with increased periprocedural adverse events including all-cause mortality. The use of frailty assessments can thus further guide clinical decision-making when considering endoscopy and risk of adverse events in adult patients with GI hemorrhage.
衰弱是住院患者死亡和不良事件的已知预测因素；然而，它尚未作为一种评估胃肠道出血（GIB）内镜检查患者风险的方式进行研究。我们旨在确定在因 GIB 住院并在入院后 2 天内行内镜检查的患者中，衰弱状态与不良事件风险之间的关联。
我们使用 2016 年和 2017 年全国住院患者样本数据库进行了队列研究，使用国际疾病分类诊断代码识别 GIB 接受内镜检查的成年患者，并使用医院衰弱风险评分将患者分类为衰弱或非衰弱。进行单变量和多变量逻辑回归模型构建，以评估围手术期不良事件的预测因素，并进行边缘标准化分析以评估年龄和衰弱之间可能存在的交互作用。
共有 757920 名患者符合纳入标准，其中 44.4%（336895 名）被确定为衰弱，55.6%（421025 名）为非衰弱；衰弱患者的复合围手术期不良事件发生率为 49.2%，而非衰弱患者为 25.5%（P<.001）。与非衰弱患者相比，衰弱患者更易发生心血管（32.1%比 17.1%，P<.001）、肺部（18.5%比 4.3%，P<.001）、胃肠道（10.1%比 6.1%，P<.001）和感染（9.9%比 7%，P<.001）不良事件。衰弱患者的全因住院死亡率也较高（4.8%比 0.5%，P<.001）。多变量分析显示，阳性衰弱状态与复合围手术期不良事件的发生可能性增加 2.13 倍相关。
在因 GIB 住院并接受内镜检查的患者中，衰弱状态与围手术期不良事件增加相关，包括全因死亡率。因此，在考虑成年 GIB 患者的内镜检查和不良事件风险时，衰弱评估的使用可以进一步指导临床决策。
