Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.
Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients / Pilotto, A; Rengo, F; Marchionni, N; Sancarlo, D; Fontana, A; Panza, F; Ferrucci, L; Branca, S; Gregorio, Td; Manmano, M; Spallina, G; Laguzzi, E; Estienne, G; Massone, A; Moscato, M; Ravera, C; Ferrara, L; Tommaso, Gd; Serenella, D; Rozzini, R; Barbisoni, P; Sleiman, I; Carrieri, V; Devicienti, C; Cristofalo, R; Argentieri, G; Salsi, A; Bellotti, L; Bernardi, R; Nicolino, F; Putzu, Pf; Caddeo, G; Coghe, F; Riccio, D; Mazzei, B; Corsonello, A; Bari, Md; Caldi, F; Lopilato, E; Tassinari, I; Tardi, S; Mascolo, Ep; Abete, P; Simione, I; Centomo, R; Cester, A; Scevola, M; Lunardelli, P; Giordano, A; Martini, E; Nardelli, A; Visioli, S; Cherubini, A; Dell'Aquila, G; Gasperini, B; Senin, U; Costanza, Am; Bavazzano, A; Gambardella, L; Malin, N; Bernabei, R; D'Arco, C; Gambassi, G; Mammarella, F; Cascavilla, L; Paris, F; Scarcelli, C; Grasselli, C; Brunello, P; Cortiana, C; Pavin, D; Cabodi, S; Carlucci, R; Grassone, D; Toigo, Gabriele; Colle, Pd; Lattuada, L; Tulliani, A.. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - (2012), pp. "-"-"-".
Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients.
TOIGO, GABRIELE;
2012-01-01
Abstract
Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.Pubblicazioni consigliate
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