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The prognostic and discriminatory utility of the Clinical Frailty Scale and modified Frailty Index compared to age

Carter, Ben, Keevil, Victoria L., Anand, Atul, Osuafor, Christopher N., Goudie, Robert J. B., Preller, Jacobus, Lowry, Matthew, Clunie, Sarah, Shenkin, Susan D., McCarthy, Kathryn, Hewitt, Jonathan ORCID: and Quinn, Terence J. 2022. The prognostic and discriminatory utility of the Clinical Frailty Scale and modified Frailty Index compared to age. Geriatrics 7 (5) , e87. 10.3390/geriatrics7050087

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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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: URL:
Publisher: MDPI
Date of First Compliant Deposit: 26 August 2022
Date of Acceptance: 21 August 2022
Last Modified: 22 May 2023 01:40

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