Anthony Nicholas Phillip, Ho Kwok Ming
Department of Intensive Care, Fiona Stanley Hospital, Perth, Australia.
Department of Anesthesia and Intensive Care, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong.
Acute Crit Care. 2025 May;40(2):264-272. doi: 10.4266/acc.000200. Epub 2025 May 28.
Frailty is a widely accepted predictor of health outcomes in patients including the critically ill. Biological age is also increasingly recognized as a determinant of chronic health outcomes. Whether these factors are independently predictive of mortality among the critically ill is unknown. We assessed whether biological age, measured as PhenoAge at Intensive Care Unit (ICU) admission, predicts mortality in critically ill patients independent of the Clinical Frailty Scale (CFS).
This single-center retrospective cohort study included adult patients with available CFS and PhenoAge data at admission to ICU, excluding patients with incomplete records for key variables. The Levine PhenoAge model was used to estimate each patient's biological age (PhenoAge). PhenoAge was then calibrated to generate a regression residual to reflect excessive biological age unexplained by chronological age.
Of the 1,073 critically ill adult patients analyzed, 117 died (10.9%) before hospital discharge. PhenoAge and CFS were significantly correlated (correlation coefficient, 0.235; P=0.001). PhenoAge (receiver operating characteristic curve [AUROC], 0.622) and its residuals (AUROC, 0.627) and CFS (AUROC, 0.601) were predictive of hospital mortality, with no significant differences in their ability to differentiate between survivors and non-survivors (paired comparison to CFS: P=0.586 and P=0.537, respectively). PhenoAge interacted with frailty in its effect on mortality (P=0.004) which was particularly prominent among those who were not clinically frail (CFS ≤3).
PhenoAge and CFS, both measured at ICU admission, independently predicted hospital mortality. PhenoAge showed a notable interaction with frailty, particularly in non-frail patients.
衰弱是包括重症患者在内的患者健康结局的一个广泛认可的预测指标。生物学年龄也日益被视为慢性健康结局的一个决定因素。这些因素是否能独立预测重症患者的死亡率尚不清楚。我们评估了以重症监护病房（ICU）入院时的表型年龄衡量的生物学年龄是否能独立于临床衰弱量表（CFS）预测重症患者的死亡率。
这项单中心回顾性队列研究纳入了成年患者，这些患者在入住ICU时可获得CFS和表型年龄数据，排除关键变量记录不完整的患者。使用莱文表型年龄模型估计每位患者的生物学年龄（表型年龄）。然后对表型年龄进行校准以生成回归残差，以反映按实足年龄无法解释的过度生物学年龄。
在分析的1073例成年重症患者中，117例（10.9%）在出院前死亡。表型年龄与CFS显著相关（相关系数为0.235；P = 0.001）。表型年龄（受试者工作特征曲线下面积[AUROC]为0.622）及其残差（AUROC为0.627）和CFS（AUROC为0.601）可预测住院死亡率，它们区分存活者和非存活者的能力无显著差异（与CFS的配对比较：P分别为0.586和0.537）。表型年龄在对死亡率的影响方面与衰弱存在相互作用（P = 0.004），这在非临床衰弱（CFS≤3）的患者中尤为突出。
在ICU入院时测量的表型年龄和CFS均可独立预测住院死亡率。表型年龄与衰弱存在显著相互作用，尤其是在非衰弱患者中。
