Department of Primary Care and Population Health, University College London, Rowland Hill Street, London NW3 2PF, United Kingdom of Great Britain and Northern Ireland.
Age Ageing. 2018 Mar 1;47(2):193-200. doi: 10.1093/ageing/afx162.
two popular operational definitions of frailty, the frailty phenotype and Frailty index (FI), are based on different theories. Although FI was shown to be superior in predicting mortality to the frailty phenotype, no meta-analysis on mortality risk according to FI has been found in the literature.
an electronic systematic literature search was conducted in August 2016 using four databases (Embase, Medline, CINAHL and PsycINFO) for prospective cohort studies published in 2000 or later, examining the mortality risk according to frailty measured by FI. A meta-analysis was performed to synthesise pooled mortality risk estimates.
of 2,617 studies identified by the systematic review, 18 cohorts from 19 studies were included. Thirteen cohorts showed hazard ratios (HRs) per 0.01 increase in FI, six cohorts showed HRs per 0.1 increase in FI and two cohorts each showed odds ratios (ORs) per 0.01 and 0.1 increase in FI, respectively. All meta-analyses suggested that higher FI was significantly associated with higher mortality risk (pooled HR per 0.01 FI increase = 1.039, 95% CI = 1.033-1.044, P < 0.001; pooled HR per 0.1 FI increase = 1.282, 95% CI = 1.258-1.307, P < 0.001; pooled OR per 0.01 FI increase = 1.054, 95% CI = 1.040-1.068, P < 0.001; pooled OR per 0.1 FI increase = 1.706, 95% CI = 1.547-1.881, P < 0.001). Meta-regression analysis among 13 cohorts with HR per 0.01 increase in FI showed that the studies with shorter follow-up periods and with lower female proportion were associated with higher mortality risks by FI.
this systematic review and meta-analysis was the first to quantitatively demonstrate that frailty measured by the FI is a significant predictor of mortality.
两种流行的衰弱操作性定义，衰弱表型和衰弱指数（FI），基于不同的理论。虽然 FI 在预测死亡率方面优于衰弱表型，但目前尚未发现文献中根据 FI 进行死亡率风险的荟萃分析。
2016 年 8 月，我们使用 4 个数据库（Embase、Medline、CINAHL 和 PsycINFO）进行电子系统文献检索，以纳入 2000 年或之后发表的前瞻性队列研究，考察 FI 测量的衰弱与死亡率风险的关系。进行荟萃分析以综合汇总死亡率风险估计值。
通过系统评价共确定了 2617 项研究，其中纳入了 19 项研究的 18 项队列研究。13 项队列研究显示 FI 每增加 0.01 时的风险比（HR），6 项队列研究显示 FI 每增加 0.1 时的 HR，2 项队列研究分别显示 FI 每增加 0.01 和 0.1 时的优势比（OR）。所有荟萃分析均表明，FI 较高与死亡率风险较高显著相关（FI 每增加 0.01 的汇总 HR = 1.039，95%CI = 1.033-1.044，P < 0.001；FI 每增加 0.1 的汇总 HR = 1.282，95%CI = 1.258-1.307，P < 0.001；FI 每增加 0.01 的汇总 OR = 1.054，95%CI = 1.040-1.068，P < 0.001；FI 每增加 0.1 的汇总 OR = 1.706，95%CI = 1.547-1.881，P < 0.001）。FI 每增加 0.01 时的 13 项队列研究的荟萃回归分析表明，随访时间较短和女性比例较低的研究与 FI 相关的死亡率风险较高有关。
本系统评价和荟萃分析首次定量证明，FI 测量的衰弱是死亡率的重要预测因素。
