The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults
- PMID: 35932256
- DOI: 10.1111/jgs.17977
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.
Keywords: FI-LAB; frailty; hospitalization; in-hospital mortality; veterans.
Published 2022. This article is a U.S. Government work and is in the public domain in the USA.
Similar articles
-
Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection.J Nutr Health Aging. 2023;27(2):89-95. doi: 10.1007/s12603-023-1886-0. J Nutr Health Aging. 2023. PMID: 36806863 Free PMC article.
-
Association between laboratory data-based frailty index and clinical health outcomes in critically ill older patients: A retrospective correlational study.Nurs Crit Care. 2025 May;30(3):e13222. doi: 10.1111/nicc.13222. Epub 2025 Jan 6. Nurs Crit Care. 2025. PMID: 39763246
-
FI-lab in the emergency department and adverse outcomes among acutely hospitalized older adults.Arch Gerontol Geriatr. 2025 Feb;129:105649. doi: 10.1016/j.archger.2024.105649. Epub 2024 Oct 1. Arch Gerontol Geriatr. 2025. PMID: 39368270
-
The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis.Age Ageing. 2023 Jan 8;52(1):afac309. doi: 10.1093/ageing/afac309. Age Ageing. 2023. PMID: 36626319 Free PMC article.
-
Development, validation and performance of laboratory frailty indices: A scoping review.Arch Gerontol Geriatr. 2023 Aug;111:104995. doi: 10.1016/j.archger.2023.104995. Epub 2023 Mar 11. Arch Gerontol Geriatr. 2023. PMID: 36963345
Cited by
-
FI-Lab predicts all-cause mortality, but not successful rehabilitation, among patients aged 65 and older after hip or pelvic fracture.Front Med (Lausanne). 2025 Jul 16;12:1627026. doi: 10.3389/fmed.2025.1627026. eCollection 2025. Front Med (Lausanne). 2025. PMID: 40740954 Free PMC article.
-
Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study.BMC Geriatr. 2023 May 17;23(1):308. doi: 10.1186/s12877-023-04029-3. BMC Geriatr. 2023. PMID: 37198576 Free PMC article.
-
A Systematic Comparison of Age, Comorbidity and Frailty of Two Defined ICU Populations in the German Helios Hospital Group from 2016-2021.J Clin Med. 2025 Mar 28;14(7):2332. doi: 10.3390/jcm14072332. J Clin Med. 2025. PMID: 40217784 Free PMC article.
-
Frailty phenotypes and their association with health consequences: a comparison of different measures.Aging Clin Exp Res. 2024 Dec 3;36(1):233. doi: 10.1007/s40520-024-02887-4. Aging Clin Exp Res. 2024. PMID: 39625598 Free PMC article. Review.
-
Accelerated pace of frailty in patients with schizophrenia.J Nutr Health Aging. 2025 Jan;29(1):100412. doi: 10.1016/j.jnha.2024.100412. Epub 2024 Nov 29. J Nutr Health Aging. 2025. PMID: 39615395 Free PMC article.
References
REFERENCES
-
- Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
-
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-762.
-
- Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722-727.
-
- Theou O, Squires E, Mallery K, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1):139.
-
- Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14(1):1.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Miscellaneous