Frailty and Sarcopenia Assessment upon Hospital
Admission to Internal Medicine Predicts Length of
Hospital Stay and Re-Admission: A Prospective
Study of 980 Patients

Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

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Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predict Worse Short-term Clinical Outcomes. 1-Year, Prospective Study of 980 patients.

10.21203/rs.3.rs-36718/v1 ◽

2020 ◽

Author(s):

Sapir Anani ◽

Gal Goldhaber ◽

Adi Brom ◽

Nir Lasman ◽

Natia Turpashvili ◽

...

Keyword(s):

Internal Medicine ◽

Hospital Admission ◽

Prospective Study ◽

Clinical Outcomes ◽

Activity Level ◽

Short Term ◽

Medicine Department ◽

Frail Patients ◽

Increased Risk ◽

Alt Activity

Abstract Background. Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized to internal medicine departments could help better prognostication of patients in the realm of internal medicine. Methods. During 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood Alanine-amino transferase (ALT) activity and Mid-Arm Muscle Circumference (MAMC) measurements. Results. We recruited Nine-hundred and eighty consecutive patients upon hospital admission (median age 72 years (IQR 65-79); 56.8% males). According to the FRAIL questionnaire 106 (10.8%) patients were robust, 368 (37.5%) pre-frail and 506 (51.7%) were frail. The Median ALT value was 19IU/L (IQR 14-28). The median MAMC value was 27.8 (IQR 25.7-30.2). Patients with low ALT activity level (< 17IU/L) were more frail according to their FRAIL score (3 (IQR 2-4) vs. 2 (IQR 1-3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30-days readmission in the whole cohort was 17.4%. Frail patients according to the FRAIL score (FS) had a higher risk for 30-days readmission (for FS > 2, HR = 1.99; 95CI = 1.29-3.08; p = 0.002). Frail patients according to low ALT activity also had a significantly higher risk for 30-days readmission (HR = 2.22; 95CI = 1.26-3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥ 10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥ 4 days (for FS > 2, HR = 1.87; 95CI = 1.39-2.52; p < 0.001). Frail patients according to low ALT activity were also at higher risk for LOS ≥ 4 days (HR = 1.87; 95CI = 1.39-2.52; p < 0.001). MAMC values were not correlated with patients' LOS or risk for re-admission. Conclusion. Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

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Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

Journal of Clinical Medicine ◽

10.3390/jcm7110386 ◽

2018 ◽

Vol 7 (11) ◽

pp. 386 ◽

Cited By ~ 12

Author(s):

Gringauz Irina ◽

Cohen Refaela ◽

Brom Adi ◽

Davidi Avia ◽

Hofstetter Liron ◽

...

Keyword(s):

Internal Medicine ◽

Prospective Study ◽

Medicine Department ◽

Internal Medicine Department ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference ◽

L 14 ◽

A Prospective Study ◽

Alt Activity

Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.

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Acute Heart Failure in an Internal Medicine Department: A Prospective Study

Electronic Journal of General Medicine ◽

10.29333/ejgm/8573 ◽

2020 ◽

Vol 18 (1) ◽

pp. em263

Author(s):

Rita Reis Correia ◽

Pedro Leite Vieira ◽

Marisa Linhares ◽

Fábia Cruz ◽

Sandra Martin ◽

...

Keyword(s):

Internal Medicine ◽

Heart Failure ◽

Prospective Study ◽

Acute Heart Failure ◽

Medicine Department ◽

Internal Medicine Department ◽

A Prospective Study

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Asymptomatic urinary retention in elderly women upon admission to the Internal Medicine department: A prospective study

Neurourology and Urodynamics ◽

10.1002/nau.23029 ◽

2016 ◽

Vol 36 (3) ◽

pp. 794-797 ◽

Cited By ~ 7

Author(s):

Dan Justo ◽

Natalia Schwartz ◽

Eliyahu Dvorkin ◽

Irina Gringauz ◽

Asnat Groutz

Keyword(s):

Internal Medicine ◽

Prospective Study ◽

Urinary Retention ◽

Elderly Women ◽

Medicine Department ◽

Internal Medicine Department ◽

A Prospective Study

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Why do frail patients with chronic heart failure die and become hospitalised?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1149 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Sze ◽

P Pellicori ◽

J Zhang ◽

J Weston ◽

A.L Clark

Keyword(s):

Heart Failure ◽

Cause Of Death ◽

Hospital Admissions ◽

Average Length ◽

Significant Proportion ◽

Length Of Hospital Stay ◽

Clinical Frailty Scale ◽

Frail Patients ◽

Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p<0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p<0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p<0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

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Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

Minimally Invasive Surgery ◽

10.1155/2013/429105 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

M. Carbonnel ◽

H. Abbou ◽

H. T. N’Guyen ◽

S. Roy ◽

G. Hamdi ◽

...

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Operative Time ◽

Group Versus ◽

Length Of Hospital Stay ◽

Benign Disease ◽

Post Surgery ◽

A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus min; ). Blood loss and length of hospital stay were significantly reduced: versus ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

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