The Electronic Frailty Index is Associated With In-hospital Mortality and Unfavorable Prognosis in Hospitalized Elderly Chinese Patients With Gastrointestinal Bleeding.

Abstract

Background: Frailty is prevalent in older adults with gastrointestinal bleeding (GIB) and is associated with unfavorable prognosis. The electronic Frailty Index (eFI) quantifies cumulative health deficits and may predict mortality and adverse events in this population.

Materials and methods: A retrospective cohort study was conducted on 1424 hospitalized patients aged 65 years or older with GIB in Beijing Hospital (2013-2019). The eFI was derived from 45 variables encompassing chronic diseases, nursing assessments, and laboratory data. Restricted cubic spline modeling and Logistic regression analyses assessed the relationships between eFI, unfavorable prognosis, and mortality.

Results: Of the 1424 hospitalized patients included, 46.0% experienced unfavorable prognosis and 30.3% died during hospitalization. A nonlinear association was observed between the eFI and both outcomes. Using a threshold of 0.27, patients were classified as frail (eFI ≥0.27) or nonfrail (eFI <0.27). Compared with nonfrail patients, those in the frail group had significantly higher adjusted risks of in-hospital mortality (OR: 3.69, 95% CI: 2.45-5.55) and unfavorable prognosis (OR: 3.51, 95% CI: 2.41-5.11). The area under the curve (AUC) for the eFI was 0.76 for predicting in-hospital mortality and 0.72 for unfavorable prognosis, indicating good discriminative ability.

Conclusion: The eFI demonstrated prognostic utility for predicting in-hospital mortality and unfavorable prognosis in older adults with GIB. The threshold of 0.27 offers a practical basis for frailty assessment and risk stratification, underscoring the importance of multidisciplinary approaches to improve outcomes in this high-risk group. Further validation in multicenter and non-Chinese cohorts is warranted.