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The association between FI-LAB and all-cause mortality in hospitalized older adults
ABSTRACT
Background:
Frailty is a common issue among hospitalized elderly patients and is associated with numerous adverse health outcomes. Assessing frailty facilitates better decision-making on treatment plans, patient placement, and discharge planning. Approximately a decade ago, the FI-LAB metric was introduced as a frailty index, based primarily on laboratory tests. This metric effectively predicts adverse health outcomes, including mortality.
Objective:
The aim of the study was to investigate the relationship between FI-LAB at admission and all-cause mortality during hospitalization and after discharge in patients aged 65 and older admitted to internal medicine departments.
Methods:
This retrospective cohort study included patients aged 65 and older hospitalized in the internal medicine departments of a large tertiary hospital. Data included demographic variables, comorbidity, and all-cause mortality. The FI-LAB was calculated based on 16 available blood tests, as well as blood pressure and heart rate measurements. Hospitalization data were collected from December 25, 2016, to January 7, 2023, and mortality data were gathered up to November 16, 2024.
Results:
During the study period, 31,443 patients were hospitalized in internal medicine departments, and FI-LAB was calculable for 31,398 of them. The mean age of the patients was 77.6 ± 8.2 years, and 52.1% were women. The mean FI-LAB score was 0.38 ± 0.15. Based on FI-LAB scores, patients were categorized into four groups: robust, mildly pre-frail, moderately pre-frail, and frail. After adjusting for age, sex, and comorbidities, frail and pre-frail patients exhibited higher mortality rates than robust patients. For each 0.01 increase in the FI-LAB score (as a continuous variable), adjusted analyses revealed a 5.5% increase in in-hospital mortality, a 2.9% increase in mortality within the first year after hospitalization, and a 1.9% increase in mortality beyond the first year.
Conclusions:
FI-LAB is a readily available and informative metric that can assist physicians in evaluating hospitalized older patients. Clinical Trial: The study was approved by the Helsinki Committee of the Soroka Medical Center (SOR-0297-23).
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