The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults

Abstract

Background Frailty, a state of vulnerability to stressors resulting from loss of physiological reserve due to multisystemic dysfunction, is common among hospitalized older adults. Hospital clinicians need objective and practical instruments that identify older adults with frailty. The FI‐LAB is based on laboratory values and vital signs and may capture biological changes of frailty that predispose hospitalized older adults to complications. The study's aim was to assess the association of the FI‐LAB versus VA‐FI with hospital and post‐hospital clinical outcomes in older adults. Methods Retrospective cohort study was conducted on Veterans aged ≥60 admitted to a VA hospital. We identified acute hospitalizations January 2011‐December‐2014 with 1‐year follow‐up. A 31‐item FI‐LAB was created from blood laboratory tests and vital signs collected within the first 48 h of admission and scores were categorized as low (<0.25), moderate (0.25–0.40), and high (>0.40). For each FI‐LAB group, we obtained odds ratio (OR) and confidence intervals (CI) for hospital and post‐hospital outcomes using multivariate binomial logistic regression. Additionally, we calculated hazard ratios (HR) and CI for all‐cause in‐hospital mortality comparing the high and moderate FI‐LAB group with the low group. Results Patients were 1407 Veterans, mean age 72.7 (SD = 9.0), 67.8% Caucasian, 96.1% males, 47.0% (n = 661), 41.0% (n = 577), and 12.0% (n = 169) were in the low, moderate, and high FI‐LAB groups, respectively. Moderate and high scores were associated with prolonged LOS, OR:1.62 (95% CI:1.29–2.03); and 3.36 (95% CI:2.27–4.99), ICU admission, OR:1.40 (95% CI:1.03–1.90); and OR:2.00 (95% CI:1.33–3.02), nursing home placement OR:2.36 (95% CI:1.26–4.44); and 5.99 (95% CI:2.83–12.70), 30‐day readmissions OR:1.74 (95% CI:1.20–2.52); and 2.20 (95% CI:1.30–3.74), 30‐day mortality OR: 2.51 (95% CI:1.01–6.23); and 8.97 (95% CI:3.42–23.53), 6‐month mortality OR:3.00 (95% CI:1.90–4.74); and 6.16 (95% CI:3.55–10.71), and 1‐year mortality OR: 2.66 (95% CI:1.87–3.79); and 4.76 (95% CI:3.00–7.54) respectively. The high FI‐LAB group showed higher risk of in‐hospital mortality, HR:18.17 (95% CI:4.01–80.52) with an area‐under‐the‐curve of 0.843 (95% CI:0.75–0.93). Conclusions High and moderate FI‐LAB scores were associated with worse in‐hospital and post‐hospital outcomes. The FI‐LAB may identify hospitalized older patients with frailty at higher risk and assist clinicians in implementing strategies to improve outcomes.

Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study

“…The third aspect of remarking is the relationship between frailty and all-cause mortality. Investigations have shown that high and moderate FI-LAB scores were associated with worse in-hospital and post-hospital outcomes, and FI-LAB can stratify older adults at increased risk of death alone [ 25 ], we proved this. According to a study using a large general older population hospitalized for pneumonia, frailty, measured by the Hospital Frailty Risk Score, was associated with mortality [ 26 ].…”

Impact of frailty on perioperative outcomes following percutaneous nephrolithotomy in older persons: evidence from the US Nationwide Inpatient Sample

“…Several studies have shown that frailty is predictive of worse outcomes in many different medical fields including general clinical outcomes for hospitalized older adults [ 16 ], neurosurgical outcomes in patients with brain tumors [ 17 ], older patients with trauma undergoing surgery [ 18 ], and older patients undergoing general surgical procedures [ 19 ]. Relatively few studies have delved into the impact of preoperative frailty on outcomes in urological conditions, rendering our study novel.…”

“…Furthermore, the intermediate and high frailty risk groups had a significantly higher risk of any complication (aOR = 3.27, 95% CI: 2.98-3.60, p < 0.001; aOR = 8.52, 95% CI: 7.69-9.45, p < 0.001, respectively). For specific complications, the intermediate and high frailty risk groups general clinical outcomes for hospitalized older adults [16], neurosurgical outcomes in patients with brain tumors [17], older patients with trauma undergoing surgery [18], and older patients undergoing general surgical procedures [19]. Relatively few studies have delved into the impact of preoperative frailty on outcomes in urological conditions, rendering our study novel.…”

“…The aging demographic presents a unique challenge, as older adults often exhibit frailty, a multifaceted clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors [16]. Recent research has continuously shown that frailty independently predict higher risks of unfavorable outcomes, including increased in-hospital mortality, postoperative complications, and prolonged hospital length of stays (LOS) in multiple surgical settings [17][18][19].…”

Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study

“…BMI, body mass index. The median (IQR) hospital stay duration was 10 (8-14), 13 (9-17) and 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days for the robust, prefrail and frail groups, respectively. The frail group had a longer hospital stay than the robust and prefrail groups (P adj <0.001, P adj =0.007, respectively).…”