Electronic frailty index based on routine blood tests may help identify at-risk seniors


Background: Accurate identification of frail older patients at hospital admission may help target interventions; however, the extent to which risk prediction tools such as the frailty index can be utilized in the acute setting remains unclear.

Study design: Single-center prospective cohort study, during April 2015–January 2017.

Setting: A tertiary care, academic medical center in the United Kingdom.

Synopsis: This study enrolled 1,750 older adults, comprising 2,552 hospital admissions. For each admission, the authors generated a frailty index, called FI-Laboratory, based on the proportion of abnormal results from 27 of the most common admission laboratory tests. The authors found that an increase in the FI-Lab was significantly associated, independent of an existing chronic frailty score, with increased proportion of inpatient days, discharge to a higher level of care, readmission rates, and mortality. Notably, researchers were unable to calculate the FI-Lab score in 11.6% of cases because of insufficient laboratory information. The single-center design of this study may limit its generalizability.

Bottom line: The FI-Laboratory may provide information, complementary to existing frailty assessments, to help identify older adults at increased risk of inpatient adverse outcomes.

Citation: Logan Ellis H et al. Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results. CMAJ. 2020;192(1)e3-8.

Dr. Hu is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

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