Application of electronic frailty index in risk assessment of in-hospital mortality in elderly patients with gastrointestinal bleeding aged 80 and over
Objective To investigate the factors contributing to in-hospital mortality among elderly patients aged 80 and above with gastrointestinal bleeding(GIB).Additionally,it seeks to assess the predictive ability of the electronic frailty index(eFI)in determining the risk of in-hospital mortality in GIB patients.Methods A retrospective analysis was performed among 624 patients aged 80 and above with GIB who were admitted to Beijing Hospital between July 2013 and September 2019.The patients were categorized into two groups based on their discharge outcomes:those who survived and those who did not.The eFI was developed using a cumulative deficit model utilizing data from the hospital's electronic medical records.The study examined the clinical features and risk factors associated with in-hospital mortality among these elderly patients.The effectiveness of eFI in predicting in-hospital mortality in elderly patients with gastrointestinal bleeding was evaluated by calculating the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results Among a total of 624 patients aged between 80 and 102 years,the average age was(83.0±6.4)years,with 339 being male.A majority of the patients,581 cases(93.1％),had an eFI≥0.15.A comparison between the survival group(380 cases)and the death group(244 cases)revealed that the latter had higher eFI values(0.39±0.09 vs.0.29±0.11,t=-11.452,P＜0.001),along with higher rates of heart failure,chronic kidney disease,and malignant tumors,as well as lower body mass index,hemoglobin,albumin,and total cholesterol levels,and higher alanine aminotransferase and D-dimer levels(all P＜0.05).Logistic regression analysis indicated that eFI(OR=2.322,95％CI:1.840-2.929,P＜0.001),malignant tumor(OR=1.833,95％CI:1.141-2.860,P＜0.001),and albumin＜35 g/L(OR=1.826,95％CI:1.200-2.777,P＜0.001)were independent risk factors for in-hospital death in elderly patients aged 80 and over with gastrointestinal bleeding.With every 0.1 increase in eFI,the risk of in-hospital death rose by 1.322 times.The AUC of eFI for predicting in-hospital mortality was 0.751(95％CI:0.713-0.789,P＜0.001).An eFI of ≥0.33 demonstrated a sensitivity of 77.9％and a specificity of 60.3％in predicting in-hospital mortality in elderly patients aged 80 and over with GIB.Conclusions The eFI serves as an important independent risk factor for in-hospital mortality among patients aged 80 and above who experience GIB.It can effectively assess the prognosis of elderly individuals facing GIB.
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