S2866 Is Frailty a Predictor of Mortality, Complications, and Healthcare Utilization in Cirrhotic Patients? A Retrospective Analysis

Introduction: Frailty is increasingly recognized as a determinant of poor outcomes in patients with cirrhosis, yet the nationwide prevalence and impact on health outcomes remain underexplored. The Hospital Frailty Risk Score (HFRS) stems from a list of International Classification of Diseases, Tenth Revision (ICD-10) CM codes which were found to be commonly associated in individuals with higher hospital use and resource utilization. The objective of this study is to evaluate the association between frailty scores and key clinical outcomes, including in-hospital mortality, length of stay (LOS), and total hospitalization costs (TOTCHG), among patients with cirrhosis using the Nationwide Inpatient Sample (NIS). Methods: A retrospective analysis of the NIS database from the years 2021 was conducted to identify adult patients with cirrhosis. Patients were stratified based on their frailty scores: low frailty (F1: < 5), intermediate frailty (F2: 5-15), and high frailty (F3: > 15). Outcomes of interest included in-hospital mortality, complications (such as hepatic encephalopathy, variceal bleeding, and ascites), length of stay (LOS), and total hospitalization charges (TOTCHG). Multivariate logistic and linear regression analyses were performed, adjusting for relevant confounders using STATA software. Results: A total of 135,139 patients with cirrhosis were included. The in-hospital mortality rate was 1.47% for low frailty (F1), 8.88% for intermediate frailty (F2), and 17.04% for high frailty (F3). The adjusted odds ratio (aOR) for in-hospital mortality was 6.41 (95% CI: 5.44-7.56) for F2 and 13.40 (95% CI: 9.35-19.20) for F3 compared to F1. Additionally, patients with frailty scores of F2 and F3 had significantly increased risks of complications, including hepatic encephalopathy (F3: aOR 1.76, 95% CI: 1.33-2.33) and variceal bleeding (F3: aOR 0.44, 95% CI: 0.33-0.59). The mean length of stay (LOS) was 4.37 days for low frailty (F1), 8.42 days for intermediate frailty (F2), and 15.00 days for high frailty (F3) patients. Similarly, total hospitalization charges were $59,000 for low frailty (F1), $123,097 for intermediate frailty (F2), and $209,448 for high frailty (F3) patients. Conclusion: Frailty is a significant predictor of adverse outcomes in hospitalized cirrhotic patients, including increased mortality, complications, length of stay, and healthcare costs. These findings underline the critical importance of incorporating frailty assessments into care for patients with cirrhosis to identify high-risk individuals and optimize resource allocation in healthcare.