Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada.
Division of Surgery Interventional Science, Institute of Sport Exercise and Health, University College London, London, UK.
Geroscience. 2024 Jun;46(3):3061-3069. doi: 10.1007/s11357-023-01055-2. Epub 2024 Jan 6.
The frailty index (FI) uses a deficit accumulation approach to derive a single, comprehensive, and replicable indicator of age-related health status. Yet, many researchers continue to seek a single "frailty biomarker" to facilitate clinical screening. We investigated the prognostic accuracy of 70 individual biomarkers in predicting mortality, comparing each with a composite FI. A total of 29,341 individuals from the comprehensive cohort of the Canadian Longitudinal Study on Aging were included (mean, 59.4 ± 9.9 years; 50.3% female). Twenty-three blood-based biomarkers and 47 test-based biomarkers (e.g., physical, cardiac, cardiology) were examined. Two composite FIs were derived: FI-Blood and FI-Examination. Mortality status was ascertained using provincial vital statistics linkages and contact with next of kin. Areas under the curve were calculated to compare prognostic accuracy across models (i.e., age, sex, biomarker, FI) in predicting mortality. Compared to an age-sex only model, the addition of individual biomarkers demonstrated improved model fit for 24/70 biomarkers (11 blood, 13 test-based). Inclusion of FI-Blood or FI-Examination improved mortality prediction when compared to any of the 70 biomarker-age-sex models. Individual addition of seven biomarkers (walking speed, chair rise, time up and go, pulse, red blood cell distribution width, C-reactive protein, white blood cells) demonstrated an improved fit when added to the age-sex-FI model. FI scores had better mortality risk prediction than any biomarker. Although seven biomarkers demonstrated improved prognostic accuracy when considered alongside an FI score, all biomarkers had worse prognostic accuracy on their own. Rather than a single biomarker test, implementation of routine FI assessment in clinical settings may provide a more accurate and reliable screening tool to identify those at increased risk of adverse outcomes.
衰弱指数 (FI) 使用缺陷积累方法得出一个单一的、综合的、可重复的与年龄相关的健康状况指标。然而,许多研究人员仍在寻求单一的“衰弱生物标志物”来促进临床筛查。我们调查了 70 种个体生物标志物在预测死亡率方面的预后准确性,将每种标志物与综合 FI 进行比较。共有 29341 名来自加拿大老龄化纵向研究综合队列的个体被纳入研究(平均年龄 59.4±9.9 岁,50.3%为女性)。共检查了 23 种基于血液的生物标志物和 47 种基于检测的生物标志物(例如,身体、心脏、心脏病学)。衍生了两个综合 FI:FI-血液和 FI-检查。通过省级生命统计链接和与近亲联系来确定死亡率状态。计算曲线下面积以比较不同模型(即年龄、性别、生物标志物、FI)在预测死亡率方面的预后准确性。与仅年龄-性别模型相比,24/70 种生物标志物(11 种血液,13 种基于检测)的单独添加改善了模型拟合度。与任何 70 种生物标志物-年龄-性别模型相比,FI-血液或 FI-检查的纳入均提高了死亡率预测。当添加到年龄-性别-FI 模型时,单独添加七种生物标志物(步行速度、椅子上升、起身和行走、脉搏、红细胞分布宽度、C 反应蛋白、白细胞)可改善拟合度。FI 评分比任何生物标志物都能更好地预测死亡风险。尽管当与 FI 评分一起考虑时,七种生物标志物显示出改善的预后准确性,但所有生物标志物单独使用时的预后准确性都更差。与其依赖于单一的生物标志物检测,在临床环境中实施常规 FI 评估可能提供更准确和可靠的筛查工具,以识别那些发生不良后果风险增加的人。