Validation of the Hospital Frailty Risk Score among older adults receiving mechanical ventilation
Bibliographic record
Abstract
Abstract Background:Older adults are increasingly being admitted to intensive care units, with frailty recognized as a risk factor for worse outcomes. The Hospital Frailty Risk Score (HFRS) was developed for use in administrative databases of older adults, but it has not yet been well-validated for critically ill patients. The objective of this study was to validate the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions in critically ill patients.Methods:We selected index hospitalizations of older adults (≥75 years old) receiving mechanical ventilation, using the United States Nationwide Readmissions Database from January 1, 2016 to November 30, 2018. Frailty risk was determined by the HFRS using International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) codes, and further subcategorized into low (score <5), intermediate (score 5-15), and high (score >15) risk for frailty. We evaluated the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions, using multivariable logistic regression after adjustment for patient and hospital characteristics. Model performance was assessed using the c-statistic, Brier score, and calibration plots.Results:Among the 649,330 weighted index hospitalizations in the cohort, 50.0% were female, the median (interquartile range [IQR]) age was 81 (78-86) years old, and the median (IQR) HFRS was 10.8 (7.7-14.5). Among the cohort, 9.5%, 68.3%, and 22.2% were subcategorized as low, intermediate, and high risk for frailty, respectively. After adjustment, patient hospitalizations with high frailty risk were associated with increased risks of prolonged hospitalization (adjusted odds ratio [aOR] 5.59 [95% confidence interval [CI] 5.24-5.97], c-statistic 0.694, Brier score 0.216) and 30-day emergency hospital readmissions (aOR 1.20 [95% CI 1.13-1.27], c-statistic 0.595, Brier score 0.162), compared to low frailty risks. Conversely, high frailty risk using the HFRS was inversely associated with in-hospital mortality (aOR 0.46 [95% CI 0.45-0.48], c-statistic 0.712, Brier score 0.214). Calibration plots demonstrated good calibration for the adjusted analyses.Conclusions:The HFRS is associated with prolonged hospitalization and 30-day readmission in older adults receiving mechanical ventilation. Further research is necessary to develop frailty scores that accurately and intuitively predict mortality in critically ill patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".