Frailty-related endogenous endophthalmitis tied to higher in-hospital death, resource use

Frailty syndrome is an independent predictor of endogenous endophthalmitis (EE) development in the setting of bacterial septicemia, suggests a recent study. Furthermore, frailty-induced EE tends to occur in patients with malnutrition and certain bacterial subtypes and may lead to greater in-hospital death and healthcare resource usage.

The study included adult inpatients within the National Inpatient Sample (2002‒2014) diagnosed with bacterial septicemia, who were then classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. EE diagnosis was abstracted from International Classification of Diseases 9 codes.

The researchers used multivariable logistic regression to calculate odds ratios (ORs) for the rates of EE development and in-hospital mortality based on frailty status. They also assessed the association of frailty with blood culture–proven organism class, inpatient length of stay, and total charges billed to insurance.

Of the 18,470,658 inpatients with bacteremia, 9,294 (0.05 percent) developed EE; among those with EE, 2,102 (22.6 percent) had at least one frailty-defining feature, particularly malnutrition (68 percent).

Frail patients had 16.7-percent higher likelihood of developing EE (OR, 1.167, 95 percent confidence interval [CI], 1.108‒1.229) when controlling for age, sex, race, concomitant HIV/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications.

Frail EE patients had 27.9-percent higher odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279, 95 percent CI, 1.056‒1.549).

Of note, frailty significantly correlated with higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3 percent vs 10.9 percent; p=0.000016), gram-negative bacteremia (7.6 percent vs 4.9 percent; p=0.000003), and concomitant candidemia (10.4 percent vs 7.0 percent; p=0.0000004).

In addition, frail EE patients also had significantly longer hospital stays (median 14 days; p<0.00001) and markedly greater total charges billed to insurance (median $96,39; p<0.00001).