Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge

Introduction

The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge.

Objectives

To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge.

Methodology

Multicentre cohort study in 2020–2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. Variables: pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. Statistics: descriptive and multivariate analysis.

Results

254 cases were included. Thirty-nine per cent were women and the median [Q1–Q3] age was 67 [56–77] years. SAPS 3 on admission (median [Q1–Q3]): 62 [51–71] points.

Frail patients on admission (CFS-Es 5–9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90–100: 82% vs. 68% vs. 65%. 2) Barthel 60–85: 15% vs. 15% vs. 20%. 3) Barthel 0–55: 3% vs. 17% vs. 15%.

In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5–9) are 2.8 times (95%CI: 1.03–7.58; p = 0.043) more likely to increase dependency (Barthel 90–100 to <90 or Barthel 85–60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18–10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01–2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge.

Conclusions

CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.