Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.
Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
Aging Clin Exp Res. 2020 Jun;32(6):1025-1034. doi: 10.1007/s40520-020-01478-3. Epub 2020 Jan 31.
The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging.
To operationalize an FI among older adults in the "Invecchiare in Chianti" (InCHIANTI) study, and to validate its predictive capacity for mortality.
Longitudinal data were used from 1129 InCHIANTI participants aged ≥ 65 years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points.
The median FI was 0.13 (IQR 0.08-0.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03-1.07, all p < 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72-0.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61-0.76). Overall, the predictive accuracy of the FI was higher in women than in men.
The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research.
衰弱指数（FI）是一种衡量老年人衰弱程度的敏感工具，越来越多地用于老龄化队列研究。
在“Invecchiare in Chianti”（InCHIANTI）研究中为老年人制定 FI，并验证其对死亡率的预测能力。
使用来自 1129 名年龄≥65 岁的 InCHIANTI 参与者的纵向数据。根据标准程序，使用基线数据（1998/2000 年）制定了一个包含 42 个项目的 FI。使用 Cox 回归研究 FI 与 3 年和 6 年全因和心血管疾病（CVD）死亡率之间的关联。通过接受者操作特征曲线（ROC）下面积（AUC）来估计预测准确性，对于连续 FI 评分和不同的切点。
FI 的中位数为 0.13（IQR 0.08-0.21）。女性和高龄者的分数较高。FI 与 3 年和 6 年全因和 CVD 死亡率相关（每增加 0.01 FI 的 HR 范围为 1.03-1.07，均<0.001）。连续 FI 评分对死亡率结果具有中等至良好的预测准确性（AUC 范围为 0.72-0.83）。当 FI 截断值在 0.15 到 0.35 之间时，该 FI 对死亡率的预测准确性为中等（AUC 范围为 0.61-0.76）。总体而言，FI 在女性中的预测准确性高于男性。
在 InCHIANTI 研究中制定的 FI 是评估全因死亡率和 CVD 死亡率风险的良好工具。未来的研究应进一步研究该 FI 作为结局指标的反应性等更多的测量特性。
