Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation.

PURPOSE: We aimed to estimate the independent effect of pre-hospital frailty (PHF) on hospital mortality and prolonged hospital length of stay (pLOS) while adjusting for other patient level factors.

METHODS: This is a cohort study of hospitalized adults with acute respiratory failure (ARF) who required invasive mechanical ventilation for ≥24h in 2013. We used inpatient/outpatient claims from a list of diagnoses from the year before index hospital admission to define PHF. Differences in characteristics/outcomes by PHF were explored using descriptive statistics; multivariable logistic regression was used to estimate association between PHF and hospital outcomes.

RESULTS: Among 1157 patients (mean age (standard deviation) 67.1 [16.4]), 53.2% had PHF. PHF was independently associated with higher hospital mortality (44.2% in PHF patients vs. 34.6% in those without, adjusted Odds Ratio (aOR) (95% Confidence Interval [CI] 1.56 (1.19-2.05), p<0.001). PHF was also significantly associated with pLOS in hospital survivors (55.5% PHF patients had pLOS versus 34.2% in those without, aOR (95% CI) 2.61 (1.87-3.65), p<0.001).

CONCLUSIONS: PHF, identified by frailty diagnoses from before index hospitalization, may be a useful approach for identifying adults with ARF at increased risk of hospital mortality and pLOS.