Correlates of Frailty in Hospitalized Older Adults with Hypertension and Its Influence on Clinical Prognosis

Figures & data

Table 1 Univariate Analysis of Factors Related to Frailty in Old Patients with Hypertension

Patient Characteristics	Non-Frail(n=18)	Pre-Frail(n=144)	Frail (n=150)	Z	P
Male	18(100)	141(97.9)	126(84)	19.746	0.000
Age	75(71,76)	81(71,87)	93(86,96)	89.189	0.000
Bedridden	3(16.7)	9(6.3)	45(30.0)	27.698	0.000
Smoking	6(33.3)	63(43.8)	39(26)	10.208	0.006
Drinking	3(16.7)	69(47.9)	36(24.0)	21.219	0.000
CCI grade				19.480	0.001
Grade 0	6(33.3)	18(12.5)	15(10.0)
Grade 1	12(66.7)	57(39.6)	75(50.0)
Past medical history
Coronary heart disease	6(33.3)	102(70.8)	120(80.0)	18.414	0.000
Hyperlipidemia	9(50.0)	51(35.4)	54(36)	1.499	0.473
Arrhythmology	3(16.7)	81(56.3)	114(76.0)	30.301	0.000
Valvular disease	3(16.7)	6(4.2)	6(4.0)	5.856	0.054
Cardiomyopathy	3(16.7)	9(6.3)	6(4.0)	4.841	0.089
Heart failure	3(16.7)	3(2.1)	15(10.0)	10.306	0.006
Diabetes	9(50.0)	63(43.8)	69(46.0)	0.327	0.849
Peptic ulcer disease	12(66.7)	81(56.3)	84(56.0)	0.768	0.681
Chronic kidney disease	0(0.0)	6(4.2)	15(10.0)	5.344	0.069
Chronic lung disease	3(16.7)	27(18.8)	21(14.0)	1.210	0.546
Tumor	3(16.7)	6(4.2)	6(4.0)	5.856	0.054
Laboratory results
Hb	131(116,141)	130(119,137)	122(110,133)	14.969	0.001
RBC	4.36(3.62,4.47)	4.10(3.79,4.40)	3.88(3.38,4.11)	17.549	0.000
WBC	7.12(6.63,8.65)	5.79(5.14,6.72)	5.72(4.85,7.42)	12.210	0.002
PLT	189(188,254)	177(144,200)	157(132,211)	19.778	0.000
CRP	0.06(0.03,0.08)	0.13(0.05,0.28)	0.15(0.08,0.41)	14.662	0.001
FIB	2.84(2.74,3.02)	2.79(2.51,3.32)	3.32(2.74,4.01)	21.988	0.000
D-dimer	0.24(0.23,0.70)	0.35(0.22,0.71)	0.71(0.37,1.22)	37.299	0.000
ALB	40.2(38.7,41.3)	39.1(36.8,41.8)	36.2(33,39.7)	54.397	0.000
TC	3.48(3.13,3.58)	3.15(2.89,3.72)	2.97(2.60,3.70)	10.035	0.007
BUN	8.1(6.6,9.2)	6.9(5.5,9.0)	7.6(5.5,10.3)	1.726	0.422
SCr	75(69,90)	90(78,111)	94(74,115)	9.473	0.009
TG	1.48(1.16,1.57)	1.04(0.79,1.53)	1.03(0.80,1.46)	3.482	0.175
TNI	0(0,0)	0.001(0,0.015)	0.007(0,0.025)	30.926	0.000
NT-proBNP	48(24.8,72.3)	160.9(79.4,694)	392.7(198.2,1739)	47.546	0.000
GLU	4.41(4.41,4.49)	4.92(4.52,5.44)	5.28(4.64,6.53)	17.974	0.000
Echocardiography
LVEF	64(61,66)	61(58,65)	61(56,63)	16.803	0.000
IVSD	10(9,10)	10(10,11)	11(10,12)	11.256	0.004
LVPWD	10(10,11)	10(10,11)	10(10,10)	0.966	0.617
LVEDD	46(45,50)	50(47,53)	48(46,52)	9.568	0.008
LVESD	33(28,33)	33(31,36)	33(31,36)	4.061	0.131

Note: Data are shown as number (percentage) or median (min and max).

Abbreviations: CCI, Charlson comorbidities index; Hb, Hemoglobin; RBC, Erythrocyte; WBC, Leukocyte; PLT, Platelets; CRP, C-reactive protein; FIB, Fibrinogen; ALB, Serum albumin; TC, Serum total cholesterol; BUN, Urea nitrogen; SCr, Serum creatinine; TG, Triglyceride; TNI, Troponin I; NT-proBNP, N-terminal pro-B-type natriuretic peptide; GLU, Fasting blood glucose; LVEF, left ventricular ejection fraction; IVSD, Interventricular Septal Thickness at Diastole; LVPWD, left ventricular posterior wall; LVEDD, Left ventricular end diastolic dimension; LVESD, Left ventricular end-systolic dimension.

Table 2 Logistic Regression Analysis of Factors Related to Frailty in Old Hypertension Patients

Correlation Factor	B	S.E.	Wald	P	OR	95% CI
CCI grade			7.021	0.030
Grade 1	−0.014	0.559	0.001	0.980	0.986	0.329–2.952
Grade 2	−1.014	0.567	3.202	0.074	0.363	0.120–1.101
Gender	3.074	0.853	12.982	0.000	21.618	4.062–115.061
Age	0.137	0.028	24.558	0.000	1.147	1.086–1.211
Bedridden	2.453	0.645	14.459	0.000	11.620	3.282–41.140
Arrhythmia	2.668	0.587	20.629	0.000	14.414	4.558–45.585
Heart failure	1.694	0.849	3.975	0.046	5.439	1.029–28.740
CRP	−0.470	0.210	4.987	0.026	0.625	0.414–0.944
FIB	0.941	0.328	8.208	0.004	2.562	1.346–4.875
D-dimmer	1.625	0.500	10.579	0.001	5.079	1.907–13.522
ALB	0.114	0.066	2.969	0.085	1.121	0.984–1.276
TC	−1.067	0.336	10.083	0.001	0.344	0.178–0.665
TNI	0.262	0.120	4.779	0.029	1.300	1.028–1.645
GLU	0.398	0.133	8.912	0.003	1.489	1.146–1.933
LVEDD	−0.091	0.042	4.704	0.030	0.913	0.842–0.991
Constant	−16.069	5.182	9.617	0.002	0.000

Abbreviations: CCI, Charlson comorbidities index; CRP, C-reactive protein; FIB, Fibrinogen; ALB, Serum albumin; TC, Serum total cholesterol; TNI, Troponin I; GLU, Fasting blood glucose; LVEDD, Left ventricular end diastolic dimension.

Table 3 Area Under Curve

Test Result Variable	Area chart	The Standard Error^a	Asymptotically Significant Level^b	95% CI
CCI grade	0.488	0.034	0.717	0.420–0.555
Gender	0.564	0.034	0.062	0.497–0.631
Age	0.805	0.026	0.000	0.754–0.856
Bedridden	0.607	0.034	0.002	0.542–0.673
Arrhythmia	0.612	0.033	0.001	0.547–0.677
Heart failure	0.543	0.034	0.212	0.476–0.610
CRP	0.595	0.034	0.006	0.529–0.661
FIB	0.675	0.032	0.000	0.612–0.737
D-dimmer	0.710	0.030	0.000	0.651–0.769
TC	0.409	0.034	0.008	0.342–0.476
TNI	0.645	0.033	0.000	0.581–0.709
GLU	0.625	0.033	0.000	0.560–0.690
LVEDD	0.417	0.034	0.015	0.351–0.483
Forecast probability	0.910	0.017	0.000	0.877–0.942

Notes: ^aAssume nonparametric. ^bOriginal hypothesis: real area =0.5.

Abbreviations: CCI, Charlson comorbidities index; CRP, C-reactive protein; FIB, Fibrinogen; TC, Serum total cholesterol; TNI, Troponin I; GLU, Fasting blood glucose; LVEDD, Left ventricular end diastolic dimension.

Figure 1 Logistic regression prediction model ROC curve.

Table 4 Follow-Up Readmissions of Old Patients with Hypertension

Frailty State	Zero Times	One Time	Two Times	Three Times	χ^2	P
Non-frail group(n=15)	15(100.0)	0(0.0)	0(0.0)	0(0.0)	26.442	<0.001
Pre-frail group(n=117)	90(76.9)	24(20.5)	3(2.6)	0(0.0)
Frail group(n=99)	48(48.5)	48(48.5)	0(0.0)	3(3.0)

Table 5 Follow-Up Outcomes of Old Patients with Hypertension

Frailty State	The Alive	The Dead	χ^2	P
Non-frail group(n=18)	18(100.0)	0(0.0)	13.870	0.001
Pre-frail group(n=142)	138(97.2)	6(4.2)
Frail group(n=150)	126(84.0)	24(16.0)

Table 6 Univariate Analysis of Readmissions and All-Cause Death in Old Patients with Hypertension

Patient Characteristics	Non- Readmissions	Readmissions	P	The Alive	The Dead	P
Male	144 (94.1)	69 (88.5)	0.129	258 (91.5)	27 (90.0)	1.000
Age	81 (71,90)	87.5 (83,94)	0.000	84 (75,93)	95 (93,97)	0.000
Length of stay	21 (14,31)	23 (13,34)	0.524	22 (14,40)	101 (25,269)	0.000
Bedridden	15 (9.8)	15 (19.2)	0.044	42 (14.9)	15 (50.0)	0.000
Smoking	57 (37.3)	18 (23.1)	0.030	105 (37.2)	3 (10.0)	0.003
Drinking	69 (45.1)	27 (34.6)	0.126	99 (35.1)	9 (30.0)	0.576
Frailty score	2 (1,3)	3 (2,4)	0.000	2 (1,3)	3 (3,4)	0.007
CCI grade			0.008			0.027
Grade 1	27 (17.6)	3 (3.8)		132 (46.8)	12 (40.0)
Grade 2	57 (37.3)	39 (50.0)		111 (39.4)	18 (60.0)
Past medical history
Coronary heart disease	96 (62.7)	69 (88.5)	0.000	201 (71.3)	27 (90.0)	0.028
Hyperlipidemia	54 (35.3)	24 (30.8)	0.492	108 (38.3)	6 (20.0)	0.048
Arrhythmology	93 (60.8)	60 (76.9)	0.014	177 (62.8)	21 (70.0)	0.434
Valvular disease	9 (5.9)	0 (0)	0.068	12 (4.3)	3 (10.0)	0.342
Cardiomyopathy	9 (5.9)	0 (0)	0.068	15 (5.3)	3 (10.0)	0.526
Heart failure	6 (3.9)	9 (11.5)	0.026	18 (6.4)	3 (10.0)	0.713
Diabetes	66 (43.1)	39 (50.0)	0.322	123 (43.6)	18 (60.0)	0.087
Peptic ulcer disease	90 (58.8)	45 (57.7)	0.869	165 (58.5)	12 (40.0)	0.052
Chronic kidney disease	9 (5.9)	9 (11.5)	0.129	15 (5.3)	6 (20.0)	0.008
Chronic lung disease	18 (11.8)	27 (34.6)	0.000	45 (16.0)	6 (20.0)	0.757
Tumor	12 (7.8)	3 (3.8)	0.244	15 (5.3)	0 (0)	0.398
Echocardiography
LVEF	62 (58,65)	60 (56,63)	0.003	61 (58,64)	54.5 (44,58)	0.000
IVSD	10 (10,11)	11 (10,11)	0.300	10 (10,11)	10.5 (10,11)	0.851
LVPWD	10 (10,11)	10 (10,10)	0.808	10 (10,11)	10 (10,10)	0.544
LVEDD	50 (47,53)	48.5 (46,51)	0.022	50 (46,52)	46.5 (43,50)	0.012
LVESD	33 (31,36)	32 (32,36)	0.784	33 (31,35)	35.5 (33,37)	0.004

Abbreviations: CCI, Charlson comorbidities index; LVEF, left ventricular ejection fraction; IVSD, Interventricular Septal Thickness at Diastole; LVPWD, left ventricular posterior wall; LVEDD, Left ventricular end diastolic dimension; LVESD, Left ventricular end-systolic dimension.

Table 7 Logistic Analysis of Readmissions Risk Factors in Old Patients with Hypertension

Risk Factor	B	S.E.	Wald	P	OR	95% CI
Frailty score	0.365	0.142	6.587	0.010	1.441	1.090–1.905
CCI grade			5.236	0.073
Grade 1	0.540	0.756	0.511	0.475	1.717	0.390–7.552
Grade 2	−0.312	0.777	0.162	0.688	0.732	0.160–3.354
Coronary heart disease	1.546	0.477	10.518	0.001	4.693	1.844–11.948
Chronic lung disease	1.520	0.412	13.645	0.000	4.574	2.042–10.248
LVEF	−0.111	0.032	12.247	0.000	0.895	0.841–0.952
LVEDD	−0.085	0.036	5.473	0.019	0.918	0.855–0.986
Constant	7.674	3.162	5.890	0.015	2151.470

Abbreviations: CCI, Charlson comorbidities index; LVEF, left ventricular ejection fraction; LVEDD, Left ventricular end diastolic dimension.

Table 8 Logistic Analysis of All-Cause Mortality Risk Factors in Old Patients with Hypertension

Risk Factor	B	S.E.	Wald	P	OR	95% CI
Age	0.183	0.059	9.719	0.002	1.201	1.070–1.348
Length of stay	0.005	0.002	4.906	0.027	1.005	1.001–1.009
Smoking	−2.315	0.835	7.689	0.006	0.099	0.019–0.507
Hyperlipidemia	1.307	0.725	3.246	0.072	3.694	0.892–15.309
LVEF	−0.182	0.045	16.204	0.000	0.834	0.763–0.911
LVEDD	−0.249	0.081	9.480	0.002	0.780	0.666–0.914
LVESD	0.265	0.087	9.288	0.002	1.304	1.099–1.546
Constant	−6.310	6.705	0.886	0.347	0.002

Abbreviations: LVEF, left ventricular ejection fraction; LVEDD, Left ventricular end diastolic dimension; LVESD, Left ventricular end-systolic dimension.