Clinical Frailty–Inflammation Phenotypes and Their Association with Treatment Failure in Older Medical Inpatients

Abstract

Background: Frailty and systemic inflammation could have a combined effect on recovery from acute illness in older people but their combined prognostic significance in general medical inpatients has not been fully characterized.

Objective: To determine the association between admission frailty–inflammation phenotypes and treatment failure among older medical inpatients.

Methods: This was a prospective observational cohort study of 100 patients ≥65 years of age during a 12-month period (January 2024 to January 2025) who were admitted to general medical wards at Sheikh Zayed Hospital Rahim Yar Khan. Frailty was determined by Clinical Frailty Scale (CFS); scores of 5–8 indicate frailty. Patients were divided into 4 groups: Robust–Low inflammation, Robust–High inflammation, Frail–Low inflammation, and Frail–High inflammation, according to the inflammation category. Treatment failure was defined as lack of clinical stability at day 5, escalation of major treatment, transfer to intensive care, or death in the hospital.

Results: There were 47 male and 53 female patients with the mean age 75.6 ± 7.5 years. 30 patients had treatment failure. Rates were 10.7%, 25.0%, 27.8%, and 50.0% across the four phenotypes, respectively (p=0.008). The frail–high inflammation phenotype was still associated with treatment failure (adjusted OR 5.72, 95% CI, 1.31–25.03; p=0.020) after adjustment. This group was also the group with the longest hospital stay, and the greatest incidence of functional decline.

Conclusions: Frailty and high inflammation were found to be most important in predicting treatment failure in older patients admitted to hospital. Clinical Frailty Scale and C-reactive protein provide a combined assessment which might be useful in the early risk stratification and individual inpatient management and to allow earlier multidisciplinary interventions during acute hospitalisation.