Ding L, Miao X, Lu J, Hu J, Xu X, Zhu H, Xu Q, Zhu S
Qin Xu, Professor, School of Nursing, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, China, Email:
J Nutr Health Aging. 2021;25(10):1241-1247. doi: 10.1007/s12603-021-1701-8.
To examine the diagnostic performance of the Tilburg Frailty Indicator (TFI), 11-factor modified frailty index (mFI-11), and 5-factor modified frailty index (mFI-5) for frailty defined by Frailty Phenotype (FP), as well as to compare the predictive ability of TFI, mFI-11, and mFI-5 for adverse outcomes in hospital among elderly patients undergoing gastric cancer surgery.
A prospective cohort study.
Hospitalization setting, Nanjing, China.
We recruited 259 elderly patients undergoing gastric cancer surgery from a tertiary hospital.
Frailty was assessed by the FP, TFI, mFI-11, and mFI-5 before surgery, respectively. The receiver operating characteristic (ROC) curves were plotted to compared the diagnostic performance of TFI, mFI-11, and mFI-5 using FP as the reference. ROC curves were used to examine the performance of TFI, mFI-11, and mFI-5 in predicting adverse outcomes. The area under the curve (AUC)>0.70 was regarded as an indicator of good performance.
The prevalence of frailty ranged from 8.5% (mFI-11) to 45.9% (TFI). The AUCs of TFI (AUC: 0.764, p<0.001) was significantly greater than that of mFI-11 (AUC: 0.600, p=0.033) and mFI-5 (AUC: 0.600, p=0.0311) in the detection of frailty defined by FP, with quite different sensitivity and specificity at their original cutoffs. TFI and mFI-11 both had statistically significant but similarly inadequate predictive accuracy for adverse outcomes in hospital, including total complications (AUCs: 0.618; 0.621), PLOS (AUCs: 0.593; 0.639), increased hospital costs (AUCs: 0.594; 0.624), and hypoproteinemia (AUCs: 0.573; 0.600). For the mFI-5, only the predictive ability for hypoproteinemia was statistically significant, with poor accuracy (AUC: 0.592, p<0.0055).
The TFI performed slightly better than mFI-11 and mFI-5 in our study. Moreover, future studies are needed to further determine an optimal frailty instrument with great diagnostic and predictive accuracy.
检验蒂尔堡衰弱指标（TFI）、11因素改良衰弱指数（mFI-11）和5因素改良衰弱指数（mFI-5）对衰弱表型（FP）定义的衰弱的诊断性能，并比较TFI、mFI-11和mFI-5对接受胃癌手术的老年患者院内不良结局的预测能力。
一项前瞻性队列研究。
中国南京的住院环境。
我们从一家三级医院招募了259例接受胃癌手术的老年患者。
术前分别通过FP、TFI、mFI-11和mFI-5评估衰弱情况。绘制受试者工作特征（ROC）曲线，以FP为参照比较TFI、mFI-11和mFI-5的诊断性能。使用ROC曲线检验TFI、mFI-11和mFI-5预测不良结局的性能。曲线下面积（AUC）>0.70被视为性能良好的指标。
衰弱患病率从8.5%（mFI-11）至45.9%（TFI）不等。在检测FP定义的衰弱方面，TFI的AUC（AUC：0.764，p<0.001）显著大于mFI-11（AUC：0.600，p=0.033）和mFI-5（AUC：0.600，p=0.0311），在其原始截断值时具有相当不同的敏感性和特异性。TFI和mFI-11对院内不良结局（包括总并发症（AUC：0.618；0.621）、肺部感染（AUC：0.593；0.639）、住院费用增加（AUC：0.594；0.624）和低蛋白血症（AUC：0.573；0.600））均具有统计学意义但同样不足的预测准确性。对于mFI-5，仅对低蛋白血症的预测能力具有统计学意义，准确性较差（AUC：0.592，p<0.0055）。
在我们的研究中，TFI的表现略优于mFI-11和mFI-5。此外，未来需要进一步研究以确定一种具有高诊断和预测准确性的最佳衰弱评估工具。
