Previsione della mortalità ad 1 anno mediante l’uso di cinque strumenti per la diagnosi di fragilità: Uno studio comparativo nei pazienti geriatrici ospedalizzati

M. Ritt, L.C. Bollheimer, C.C. Sieber, K.G. Gaßmann

Arch Gerontol Geriatr. 2016;66:66-72

Data comparing the ability of different major frailty instruments for predicting mortality in hospitalized geriatric patients are 307 patients ≥65years who were hospitalized in geriatric wards were included in this prospective analysis. A fifty-item frailty index (FI), a ten-domain+co-morbidity frailty index based on a standardized comprehensive geriatric assessment (FI-CGA), the nine category Clinical Frailty Scale (CFS-9), the CSHA rules-based frailty definition (CSHA-RBFD), and the frailty phenotype (FP) were assessed during the patients' hospital stays. Patients were followed up over a one-year period.

Follow-up data could be obtained from 305 out of the 307 participants. Sixty two participants (20.3%) had died after that time. The FI, FI-CGA, CFS-9, CSHA-RBFD, and FP could all discriminate between patients who died and those who survived during follow-up (areas under the ROC curves: 0.805, 0.808, 0.852, 0.703 and 0.757, all P<0.001, respectively). The CFS-9 showed a better discriminative ability for one-year mortality compared to the FI, FI-CGA, CSHA-RBFD, and FP (all P<0.05, respectively). The FI and the FI-CGA did not differ in their discriminative ability for one-year mortality (P=0.440). The CSHA-RBFD and the FP demonstrated a comparable discriminative ability (P=0.241) and, when compared to the CFS-9, FI, and FI-CGA, an inferior discriminative ability for one-year mortality (all P<0.05, respectively).

Comment: The Clinical Frailty Scale, which, in contrast to the other frailty instruments that were evaluated in this study, takes, among other aspects, also physicians judgment in term of the patient’ s remaining life expectancy into account, showed a superior ability to predict one-year mortality when compared to the fifty-item frailty index, the ten-domains + comorbidity FI-CGA , CSHA rules based frailty definition, and the frailty phenotype in our cohort of older hospitalized patients on geriatric wards. Accordingly, the Clinical Frailty Scale could be the tool of first choice for estimating one-year mortality by using a frailty instrument in this setting. The fifty-item frailty index and the ten-domains + co-morbidity FI-CGA might be valuable and comprehensive alternatives.