J Nutr Health Aging
THE JOURNAL OF NUTRITION, HEALTH & AGING©
THE PHYSICAL PHENOTYPE OF FRAILTY FOR RISK STRATIFICATION OF OLDER MEDICAL INPATIENTS P. FORTI1, F. MAIOLI2, E. ZAGNI1, T. LUCASSENN1, L. MONTANARI1, B. MALTONI1, G. LUCA PIRAZZOLI1, G. BIANCHI1, M. ZOLI1 1. Department of Medical and Surgical Sciences, University of Bologna, Italy; 2. Geriatric Stroke Unit, Medical Department, Maggiore Hospital, Bologna, Italy. Corresponding author: Paola Forti, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, I-40138 Bologna, Italy. Fax: 0039-051-632210. Phone: 0039-051-6362270. Email: [email protected]
Abstract: Objectives: To determine the usefulness of physical phenotype of frailty, cognitive impairment, and serum albumin for risk stratification of elderly medical impatients. Design: Prospective, observational cohort study. Setting: A general internal medicine unit of a university hospital in Italy. Participants: Inpatients with an average age of 80.8 ± 7.5 yr (N=470). Measurements: Frailty was defined using the Study of Osteoporotic Fractures Index, a parsimonious version of the physical phenotype (two of the following markers: weight loss, inability to rise five times from a chair, and exhaustion). Two frailty markers from non-physical dimensions were also evaluated: cognitive impairment (Mini-Cog score < 3) and low serum albumin on ward admission (< 3,5 gr/dl). Logistic regression adjusted for preadmission and admission-related confounders was used to investigate whether the physical phenotype of frailty and the two non-physical markers were associated with ward length of stay and unfavorable discharge (death plus any other ward discharge disposition different from direct return home). Areas Under the receiver operating characteristic Curve (AUCs) and Likelihood Ratios (LRs) were used for evaluation of discriminatory ability and clinical usefulness of significant predictors. Results: The physical phenotype of frailty was associated with both study outcomes (p10 and –LR 8 days SOF-I score ≥1 ≥2 Individual markers Poor mobility Unfavorable discharge SOF-I score ≥1 ≥2 Individual markers Poor mobility Cognitive Impairment Low serum albumin
Sensitivity
Specificity
AUC *
95%CI
P-value
+ LR †
95%CI
- LR ‡
95%CI
0.91 0.61
0.22 0.53
0.564 0.570
(0.512-0.616) (0.518-0.622)
0.016 0.008
1.16 1.29
(1.07-1.26) (1.10-1.53)
0.42 0.73
(0.26-0.68) (0.60-0.90)
0.74
0.44
0.591
(0.540-0.642)
0.001
1.33
(1.16-1.52)
0.59
(0.45-0.76)
0.93 0.68
0.19 0.51
0.559 0.539
(0.499-0.619) (0.533-0.653)
0.053 0.002
1.15 1.38
(1.07-1.23) (1.17-1.62)
0.38 0.63
(0.20-0.74) (0.48-0.84)
0.85 0.69 0.60
0.44 0.54 0.58
0.639 0.617 0.590
(0.580-0.698) (0.558-0.676) (0.530-0.650)
< 0.001 0.001 0.003
1.50 1.51 1.43
(1.33-1.69) (1.28-1.78) (1.18-1.73)
0.35 0.57 0.70
(0.23-0.54) (0.43-0.75) (0.55-0.87)
LOS = ward length of stay; SOF-I = Study of Osteoporotic Fractures Index; 95%CI = 95% confidence interval; * AUC, area under the curve; † +LR, positive likelihood ratio; ‡-LR, negative likelihood ratio.
Table 4 Interaction of Physical and Non-Physical Frailty Markers for Prediction of Unfavorable Ward Discharge in Elderly Medical Impatients * Predictors Cognitive impairment
Low albumin
OR
95%CI
P-value
With
OR
95%CI
P-value
Without
SOF-I status Prefrail Frail Low albumin
2.25 2.84 1.00
0.59-8.54 0.76-10.60 0.53-1.88
0.233 0.121 0.987
3.14 6.96 4.99
0.82-11.99 1.86-26.10 2.03-12.29
0.094 0.004
THE JOURNAL OF NUTRITION, HEALTH & AGING©
THE PHYSICAL PHENOTYPE OF FRAILTY FOR RISK STRATIFICATION OF OLDER MEDICAL INPATIENTS P. FORTI1, F. MAIOLI2, E. ZAGNI1, T. LUCASSENN1, L. MONTANARI1, B. MALTONI1, G. LUCA PIRAZZOLI1, G. BIANCHI1, M. ZOLI1 1. Department of Medical and Surgical Sciences, University of Bologna, Italy; 2. Geriatric Stroke Unit, Medical Department, Maggiore Hospital, Bologna, Italy. Corresponding author: Paola Forti, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, I-40138 Bologna, Italy. Fax: 0039-051-632210. Phone: 0039-051-6362270. Email: [email protected]
Abstract: Objectives: To determine the usefulness of physical phenotype of frailty, cognitive impairment, and serum albumin for risk stratification of elderly medical impatients. Design: Prospective, observational cohort study. Setting: A general internal medicine unit of a university hospital in Italy. Participants: Inpatients with an average age of 80.8 ± 7.5 yr (N=470). Measurements: Frailty was defined using the Study of Osteoporotic Fractures Index, a parsimonious version of the physical phenotype (two of the following markers: weight loss, inability to rise five times from a chair, and exhaustion). Two frailty markers from non-physical dimensions were also evaluated: cognitive impairment (Mini-Cog score < 3) and low serum albumin on ward admission (< 3,5 gr/dl). Logistic regression adjusted for preadmission and admission-related confounders was used to investigate whether the physical phenotype of frailty and the two non-physical markers were associated with ward length of stay and unfavorable discharge (death plus any other ward discharge disposition different from direct return home). Areas Under the receiver operating characteristic Curve (AUCs) and Likelihood Ratios (LRs) were used for evaluation of discriminatory ability and clinical usefulness of significant predictors. Results: The physical phenotype of frailty was associated with both study outcomes (p10 and –LR 8 days SOF-I score ≥1 ≥2 Individual markers Poor mobility Unfavorable discharge SOF-I score ≥1 ≥2 Individual markers Poor mobility Cognitive Impairment Low serum albumin
Sensitivity
Specificity
AUC *
95%CI
P-value
+ LR †
95%CI
- LR ‡
95%CI
0.91 0.61
0.22 0.53
0.564 0.570
(0.512-0.616) (0.518-0.622)
0.016 0.008
1.16 1.29
(1.07-1.26) (1.10-1.53)
0.42 0.73
(0.26-0.68) (0.60-0.90)
0.74
0.44
0.591
(0.540-0.642)
0.001
1.33
(1.16-1.52)
0.59
(0.45-0.76)
0.93 0.68
0.19 0.51
0.559 0.539
(0.499-0.619) (0.533-0.653)
0.053 0.002
1.15 1.38
(1.07-1.23) (1.17-1.62)
0.38 0.63
(0.20-0.74) (0.48-0.84)
0.85 0.69 0.60
0.44 0.54 0.58
0.639 0.617 0.590
(0.580-0.698) (0.558-0.676) (0.530-0.650)
< 0.001 0.001 0.003
1.50 1.51 1.43
(1.33-1.69) (1.28-1.78) (1.18-1.73)
0.35 0.57 0.70
(0.23-0.54) (0.43-0.75) (0.55-0.87)
LOS = ward length of stay; SOF-I = Study of Osteoporotic Fractures Index; 95%CI = 95% confidence interval; * AUC, area under the curve; † +LR, positive likelihood ratio; ‡-LR, negative likelihood ratio.
Table 4 Interaction of Physical and Non-Physical Frailty Markers for Prediction of Unfavorable Ward Discharge in Elderly Medical Impatients * Predictors Cognitive impairment
Low albumin
OR
95%CI
P-value
With
OR
95%CI
P-value
Without
SOF-I status Prefrail Frail Low albumin
2.25 2.84 1.00
0.59-8.54 0.76-10.60 0.53-1.88
0.233 0.121 0.987
3.14 6.96 4.99
0.82-11.99 1.86-26.10 2.03-12.29
0.094 0.004
