(501) The Prognostic Impact of the Hospital Frailty Risk Score in Critically Ill Patients With COVID-19

Introduction: Frailty is associated with increased mortality in critically ill patients with COVID-19. However, studies to date were based on clinical assessment tools of frailty, which cannot be scaled to administrative data. Although several ICD code-based frailty assessment tools were validated in administrative data, their prognostic associations in critically ill patients with COVID-19 are unknown. We examined the population-level association of the Hospital Frailty Risk Score (HFRS) with short-term mortality among critically ill patients with COVID-19.

Methods: We used a statewide dataset to identify hospitalizations with ICU admission aged ≥18 years in Texas, with a principal diagnosis of COVID-19 during April 1-December 31, 2020. COVID-19 was defined by ICD-10 code U07.1. HFRS was determined by previously reported ICD-10 code-based taxonomy and categorized by risk of frailty as low ( < 5 points), intermediate (5-15 points), and high (>15 points). Hierarchical logistic models were fit to estimate the association of HFRS >15 (with HFRS < 5 as reference) with short-term mortality (defined as in-hospital death or discharge to hospice) among ICU admissions. Similar approach was used to model the prognostic association of HFRS ≥5.

Results: Among 52,776 ICU admissions, HFRS was < 5 in 24,795 (47.0%), 5-15 in 26,247 (49.7%), and >15 in 1,734 (3.3%). Compared to ICU admissions with HFRS < 5, those with HFRS >15 were older (aged ≥65 years, 80.6% vs 34.2%), more commonly female (53.3% vs 45.6%), less commonly racial/ethnic minority (52.2% vs 62.8%), and had higher mean [SD] Charlson Comorbidity Index (2.8 [1.9] vs 0.7 [1.3]), and number of organ dysfunctions (2.7 [1.3] vs 0.9 [0.7]); p < 0.0001 for all comparisons. Short-term mortality among ICU admissions with HFRS < 5, 5-15, and >15 was 6.7%, 30.3%, and 43.0%, respectively. On adjusted analyses, the risk of short-term mortality was higher among ICU admissions with HFRS >15 (adjusted odds ratio [aOR] 1.48 [95% CI 1.27-1.73] vs HFRS < 5 as reference) and among those with HFRS ≥5 (aOR 1.53 [95% CI 1.41-1.65]).

Conclusions: HFRS was associated with nearly 50% higher risk of short-term mortality among critically ill patients with COVID-19 classified as having high risk of frailty, as well as among those categorized as intermediate or high risk.