The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome

Wojciech Nowak; Ilona Kowalik; Micha? Nowicki; Tomasz Cichocki; Janina St?pińska

摘要：BACKGROUND Acute coronary syndrome (ACS) is linked to a range of in-hospital complications, and age is recognized as risk factor for adverse events. Discrepancies between physiological and chronological age are explained by frailty. However, the relationship between frailty and in-hospital complications is not clear. METHODS Assessment of frailty in patients was carried out using the FRAIL scale. In-hospital complications assessed in-cluded, bleeding, infection, arrhythmia, acute kidney injury (AKI), delirium, stroke/transient ischemic attack (TIA), liver injury, hypoglycemia, length of stay in the cardiac care unit (CCU). RESULTS Of the 174 patients, frailty was identified in 39.1％ and pre-frailty in 29.9％. Frailty was associated with a higher in-cidence of all types of bleeding (frail vs. robust: 45.5％ vs. 16.7％, P < 0.001) and infection (54.4％ vs. 11.1％, P < 0.001), including pneumonia/lower respiratory tract infections (LRTI) and urinary tract infections (UTI). Incidence of antibiotic therapy (52.9％ vs. 13.0％, P < 0.001), atrial fibrillation (AF) (47.1％ vs. 9.3％, P < 0.001), AKI (57.3％ vs. 20.4％, P < 0.001), delirium (52.9％ vs. 3.7％, P <0.001), liver injury, were higher in frail patients (17.6％ vs. 0, P = 0.001), whilst their length of stay in the CCU was longer (4 days (2-6.5) vs. 2 days (2-3), P < 0.001). Infections, pneumonia/LRTI, antibiotic therapy during hospitalization, the incidence of AF and liver injury were more often in patients with pre-frailty compared to the robust group. After adjustment for potential confoun-ders, frailty remained independently associated with an increased risk of infection (OR: 3.3 [1.6-7.0]), including pneumonia/LRTI (OR: 2.5 [1.1-5.8]) and UTI (OR: 4.8 [1.8-12.5]). Frail individuals had an increased requirement for antibiotic therapy (OR: 3.9 [1.9-8.1]), and greater risk of AF (OR: 3.5 [1.3-9.3]), AKI (OR: 2.6 [1.2-5.3]) delirium (OR: 11.7 [4.8-28.7]), as well as having to stay longer in the CCU (> 3 days) (OR: 3.7 [1.9-7.3]).CONCLUSIONS Frailty was associated with an increased risk of numerous in-hospital complications in elderly patients who had been hospitalized with ACS.