The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age
Abstract
:1. Introduction
Objectives
2. Methods
2.1. Study Design
2.2. Ethics and Data Availability
2.3. Population
2.4. Prognostic Factors
2.5. Outcomes
2.6. Statistical Analyses
3. Results
3.1. Day 28 Mortality
3.2. Prolonged Admission
3.3. Discrimination
3.4. Validation Cohort
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Day 28 Mortality | |||
---|---|---|---|
Dead | Alive | Total | |
Sites | n = 377 (37.8%) | n = 621 (62.2%) | n = 998 (%) |
Age | |||
65–69 yrs | 23 (19.8) | 93 (80.2) | 116 (11.6) |
70–74 yrs | 58 (33.9) | 113 (66.1) | 171 (17.1) |
75–79 yrs | 81 (39.1) | 126 (58.3) | 207 (20.7) |
80–84 yrs | 90 (41.7) | 92 (59.7) | 216 (21.6) |
85–89 yrs | 62 (40.3) | 92 (59.7 | 154 (15.4) |
90 yrs or older | 63 (47.0) | 71 (53.0) | 134 (13.4) |
Female | 152 (33.6) | 301 (66.5) | 453 (45.4) |
Current smokers | 17 (32.1) | 36 (67.8) | 53 (5.3) |
Diabetes | 123 (38.9) | 193 (61.8) | 316 (31.7) |
Hypertension | 55 (38.7) | 87 (61.3) | 142 (14.2) |
Hypertension (on treatment) | 157 (37.0) | 268 (63.1) | 425 (42.6) |
Coronary Artery Disease | 123 (44.7) | 152 (55.3) | 275 (27.6) |
Elevated CRP (>40) | 294 (44.1) | 372 (55.9) | 666 (66.7) |
eGFR ≥ 60 | 167 (31.8) | 359 (68.3) | 526 (52.7) |
COPD | 90 (45.2) | 109 (54.8) | 199 (19.9) |
Heart Failure | 84 (49.7) | 85 (50.3) | 169 (16.9) |
Modified Frailty Index Items (mFI) | |||
0 | 95 (37.0) | 162 (63.0) | 257 (25.8) |
1 | 80 (31.4) | 175 (68.6) | 255 (25.6) |
2 | 119 (37.3) | 200 (62.7) | 319 (32.0) |
3 | 68 (50.4) | 67 (49.6) | 135 (13.5) |
4 | 10 (40.0) | 15 (60.0) | 25 (2.5) |
5 | 5 (71.4) | 2 (28.6) | 7 (0.7) |
Clinical Frailty Scale (CFS) | |||
1, Very Fit | 6 (30.0) | 14 (70.0) | 20 (2.0) |
2, Fit | 18 (29.5) | 43 (70.5) | 61 (6.11) |
3, Managing well | 39 (27.1) | 105 (72.9) | 144 (14.4) |
4, Very Mildly frail | 50 (35.0) | 93 (65.0) | 143 (14.3) |
5, Mildly frail | 56 (34.8) | 105 (65.2) | 161 (16.3) |
6, Moderately Frail | 89 (40.8) | 129 (59.2) | 218 (21.8) |
7, Severely frail | 87 (44.4) | 109 (55.6) | 196 (19.6) |
8, Very severely frail | 32 (58.2) | 23 (41.8) | 55 (5.5) |
Crude Odds Ratio (OR) | Base Model Adjusted OR (aOR) & | Base + Age aOR | Base + CFS (Binary) aOR | Base + mFI (Binary) aOR | ||||||
---|---|---|---|---|---|---|---|---|---|---|
OR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | |
Constant | 0.52 (0.36–0.75) | <0.001 | 0.25 (0.16–0.40) | <0.001 | 0.126 (0.07–0.22) | <0.001 | 0.145 (0.09–0.24) | <0.001 | 0.199 (0.12–0.32) | <0.001 |
Sex (Female) | Ref | - | ||||||||
Male | 1.32 (1.01–1.72) | 0.044 | 1.26 (0.96–1.65) | 0.10 | 1.33 (1.01–1.76) | 0.043 | 1.41 (1.07–1.87) | 0.016 | 1.30 (0.99–1.72) | 0.06 |
Smoking (Never/Ex) | Ref | - | ||||||||
Current smoker | 0.78 (0.42–1.45) | 0.44 | 0.77 (0.41–1.44) | 0.41 | 0.81 (0.43–1.54) | 0.52 | 0.69 (0.36–1.29) | 0.25 | 0.76 (0.41–1.43) | 0.40 |
Elevated CRP (≥40) | 2.37 (1.75–3.21) | <0.001 | 2.33 (1.72–3.16) | <0.001 | 2.56 (1.88–3.49) | <0.001 | 2.47 (1.81–3.36) | <0.001 | 2.34 (1.73–3.18) | <0.001 |
Age Group (65–74) | ||||||||||
75–84 yrs | 1.87 (1.34–2.62) | <0.001 | 2.01 (1.43–2.84) | <0.001 | ||||||
85–94 yrs | 2.18 (1.50–3.17) | <0.001 | 2.58 (1.75–3.81) | <0.001 | ||||||
95 or older | 4.64 (1.78–12.13) | 0.002 | 5.49 (2.09–14.39) | <0.001 | ||||||
CFS (Not Frail) | Ref | - | ||||||||
Frail | 1.83 (1.36–2.45) | <0.001 | 2.12 (1.56–2.872.87) | <0.001 | ||||||
mFI (Not-Frail) | Ref | - | ||||||||
Frail | 1.49 (1.13–1.96) | 0.004 | 1.53 (1.16–2.03) | 0.003 | ||||||
CFS (1–4) | Ref- | Ref- | ||||||||
CFS 5 | 1.27 (0.84–1.90) | 0.26 | ||||||||
CFS 6 | 1.88 (1.30–2.73) | 0.001 | ||||||||
CFS 7–8 | 2.33 (1.62–3.45) | <0.001 |
Crude Odds Ratio (OR) | Base Model Adjusted OR (aOR) & | Base + Age aOR | Base + CFS (Binary) aOR | Base + mFI (Binary) aOR | ||||||
---|---|---|---|---|---|---|---|---|---|---|
OR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | aOR (95%CI) | p | |
Constant | 2.64 (1.77–3.92) | <0.001 | 2.62 (1.62–4.23) | <0.001 | 1.74 (1.02–2.96) | 0.04 | 1.47 (0.91–2.36) | 0.12 | 2.22 (1.35–3.65) | 0.002 |
Sex (Female) | Ref- | |||||||||
Male | 1.06 (0.79–1.41) | 0.71 | 1.06 (0.79–1.42) | 0.70 | 1.13 (0.84–1.73) | 0.43 | 1.21 (0.90–1.64) | 0.21 | 1.08 (0.81–1.45) | 0.59 |
Smoking (Never/Ex) | Ref- | |||||||||
Current smoker | 0.69 (0.37–1.29) | 0.25 | 0.69 (0.37–1.29) | 0.25 | 0.75 (0.40–1.42) | 0.38 | 0.60 (0.32–1.14) | 0.12 | 0.69 (0.37–1.29) | 0.25 |
Elevated CRP (≥40) | 0.99 (0.73–1.35) | 0.98 | 0.99 (0.73–1.35) | 0.95 | 1.06 (0.78–1.46) | 0.70 | 1.04 (0.76–1.43) | 0.81 | 0.99 (0.72–1.35) | 0.92 |
Age Group (65–74) | ||||||||||
75–84 yrs | 1.23 (0.88–1.71) | 0.23 | 1.24 (0.88–1.73) | 0.22 | ||||||
85–94 yrs | 2.49 (1.64–3.79) | <0.001 | 2.52 (1.65–3.86) | <0.001 | ||||||
95 or older | 2.19 (0.70–6.84) | 0.18 | 2.24 (0.71–7.04) | 0.17 | ||||||
CFS (Not Frail) | Ref- | |||||||||
Frail | 2.32 (1.71–3.14) | <0.001 | 2.44 (1.79–3.30) | <0.001 | ||||||
mFI (Not-Frail) | Ref- | |||||||||
Frail | 1.39 (1.03–1.86) | 0.03 | 1.39 (1.04–1.88) | 0.028 |
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Carter, B.; Keevil, V.L.; Anand, A.; Osuafor, C.N.; Goudie, R.J.B.; Preller, J.; Lowry, M.; Clunie, S.; Shenkin, S.D.; McCarthy, K.; et al. The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age. Geriatrics 2022, 7, 87. https://doi.org/10.3390/geriatrics7050087
Carter B, Keevil VL, Anand A, Osuafor CN, Goudie RJB, Preller J, Lowry M, Clunie S, Shenkin SD, McCarthy K, et al. The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age. Geriatrics. 2022; 7(5):87. https://doi.org/10.3390/geriatrics7050087
Chicago/Turabian StyleCarter, Ben, Victoria L. Keevil, Atul Anand, Christopher N. Osuafor, Robert J. B. Goudie, Jacobus Preller, Matthew Lowry, Sarah Clunie, Susan D. Shenkin, Kathryn McCarthy, and et al. 2022. "The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age" Geriatrics 7, no. 5: 87. https://doi.org/10.3390/geriatrics7050087
APA StyleCarter, B., Keevil, V. L., Anand, A., Osuafor, C. N., Goudie, R. J. B., Preller, J., Lowry, M., Clunie, S., Shenkin, S. D., McCarthy, K., Hewitt, J., & Quinn, T. J. (2022). The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age. Geriatrics, 7(5), 87. https://doi.org/10.3390/geriatrics7050087