Purpose

Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients.

Design

Population-level, retrospective cohort study.

Participants

Adult inpatients within the National Inpatient Sample (years 2002–2014) diagnosed with bacterial septicemia.

Methods

Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture–proven organism class, inpatient length of stay, and total charges billed to insurance.

Main Outcome Measures

Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture–proven microbe type, length of stay, and total charges billed to insurance.

Results

9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108–1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056–1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P = 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P = 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients.

Conclusions

Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage.

中文翻译：

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衰弱综合征对内源性眼内炎的发展和结果的影响

目的

表征衰弱对败血症患者内源性眼内炎 (EE) 发展和临床结果的影响。

设计

人口水平的回顾性队列研究。

参加者

全国住院患者样本（2002-2014 年）中被诊断患有细菌性败血症的成年住院患者。

方法

使用先前验证的约翰霍普金斯调整临床组虚弱定义诊断指标将败血症患者分类为虚弱或非虚弱，并且 EE 的诊断从国际疾病分类 9 代码中提取。我们使用多变量逻辑回归来生成 EE 发展率和基于虚弱状态的院内死亡率的比值比 (OR)。我们还研究了虚弱与血培养证实的生物体类别、住院时间和保险总费用之间的关联。

主要观察指标

败血症患者中 EE 的发生率；虚弱和非虚弱患者的 EE 发展率；血培养证明的微生物类型、住院时间长短和向保险公司收取的总费用。

结果

18 470 658 名菌血症住院患者中有 9294 名 (0.05%) 出现 EE，其中 2102 名 (22.6%) 至少有 1 项虚弱定义特征（主要是营养不良 [68%]）。在控制年龄、性别、种族、伴随的人类免疫缺陷病毒/艾滋病、化脓性肝脓肿、感染性心内膜炎、肝硬化、和糖尿病伴有慢性并发症。虚弱 EE 患者的院内死亡几率增加 27.9%，与年龄、性别、种族和 Elixhauser 合并症评分无关（OR，1.279；95% 置信区间，1.056–1.549）。较高的耐甲氧西林金黄色葡萄球菌菌血症发生率（14.3% 对 10.9%，P = 0.000016）、革兰氏阴性菌血症（7.6% 对 4.9%，P  = 0.000003）和伴随的念珠菌血症（10.4% 对 7.0%，P = 0.0000004）与虚弱有关。在虚弱的 EE 患者中，住院时间显着更长（中位数，14 天；四分位距，19 天；P < 0.00001）并且向保险支付的总费用显着更高（中位数，96 398 美元；四分位距，154,682 美元；P < 0.00001）。

结论

在细菌性败血症的情况下，虚弱综合征与 EE 的发展独立相关；虚弱相关的 EE 可能发生在营养不良和特定细菌亚型的患者中，并且它容易导致更高的院内死亡率和医疗资源使用率。