The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age.
The Prognostic and Discriminatory Utility of the Clinical Frailty Scale and Modified Frailty Index Compared to Age.
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DOI：
10.3390/geriatrics7050087
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发表时间：
2022-08-24
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背景：对于评估虚弱的最佳方法没有达成共识。我们比较了两种方法（改良虚弱指数[mFI]，临床虚弱量表[CFS]）在因COVID-19住院的老年人（≥65岁）与年龄的预后效用。方法：我们使用了一个测试和验证队列，招募了2020年2月27日至6月30日期间因COVID-19住院的参与者。采用多变量混合效应logistic模型，以28天死亡率作为主要结局。巢式模型之间进行了比较的基础模型，年龄和虚弱的评估，使用似然比检验（LRT）和受试者工作曲线下面积（AUROC）。结果：主要队列招募了来自13个中心的998名参与者。中位年龄为80岁（范围：65-101岁），453例（45%）为女性，377例（37.8%）在28天内死亡。在具有相似特征的另外两个中心（n = 672）的验证队列中重复样本。在主要队列中，mFI和CFS均与基础模型中的死亡率相关。当将CFS拟合到基础模型+mFI时，精确度提高（LRT = 25.87，p < 0.001）;然而，当将mFI拟合到基础模型+CFS时，没有改善（LRT = 1.99，p = 0.16）。AUROC表明，与年龄（p = 0.02）和年龄+MFI（p = 0.03）相比，拟合CFS时的区分度增加。相比之下，MFI在任何比较中均未提供改善的辨别力（p > 0.05）。在验证队列中观察到类似结果。结论：这些观察结果表明，CFS在预测COVID-19后死亡率方面的预后价值上级mFI。我们的数据不支持使用MFI作为辅助临床决策和预后的工具。
Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27 February and 30 June 2020. Multivariable mixed-effects logistic modelling was undertaken, with 28-day mortality as the primary outcome. Nested models were compared between a base model, age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres. The median age was 80 (range:65–101), 453 (45%) were female, and 377 (37.8%) died within 28 days. The sample was replicated in a validation cohort of two additional centres (n = 672) with similar characteristics. In the primary cohort, both mFI and CFS were associated with mortality in the base models. There was improved precision when fitting CFS to the base model +mFI (LRT = 25.87, p < 0.001); however, there was no improvement when fitting mFI to the base model +CFS (LRT = 1.99, p = 0.16). AUROC suggested increased discrimination when fitting CFS compared to age (p = 0.02) and age +mFI (p = 0.03). In contrast, the mFI offered no improved discrimination in any comparison (p > 0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision-making and prognosis.