The Hospital Frailty Risk Score as a Useful Inpatient Prognostic tool for Clostridioides difficile infections: A Nationwide Assessment

Abstract

Abstract Background Data regarding the inpatient mortality, morbidity, and healthcare resource utilization of Clostridioides difficile infection (CDI) among frail individuals remain limited. Aims We aimed to assess the Hospital Frailty Risk Score (HFRS) on the inpatient mortality, morbidity and healthcare resource utilization among CDI-related hospitalizations. Methods Using the Nationwide Inpatient Sample, we compared the odds of inpatient mortality and morbidity of primary CDI-related hospitalizations among individuals with LFS (low frailty scores), IFS (intermediate frailty scores), and HFS (high frailty scores). Results Overall, a total of 415,300 primary hospitalizations for CDI were recorded from 2016–2020. 185,950 had LFS, while 218,850 had IFS, and 10,495 had HFS. Frail individuals had a 4-7-fold increase in mortality (IFS: aOR = 4.19, 95%CI: 2.65–6.64; HFS: aOR = 6.67, 95%CI: 3.47–12.81), and were at increased odds of in-hospital morbidity (including secondary sepsis, respiratory failure, acute heart failure, AKI, dialysis use, CVA, and DVT) as compared to those with LFS. Frail individuals stayed on average 2–4 day longer, and had significantly increased healthcare expenditure, as compared to those with LFS. Conclusion In summary, our study presents strong evidence in support of using the HFRS as an index to predict the mortality and morbidity associated with CDI. An emphasis on prevention and early effective treatment of CDI should be implemented, especially in frail patients at risk.