• Hugh Logan Ellis, Bettina Wan, Michael Yeung, Arshad Rather, Imran Mannan, Catherine Bond, Catherine Harvey, Nadia Raja, Peter Dutey-Magni, Kenneth Rockwood, Daniel Davis, and Samuel D Searle.
• University College London Hospitals NHS Foundation Trust (Logan Ellis, Wan, Yeung, Rather, Mannan, Bond, Harvey, Raja, Davis); Institute of Health Informatics (Dutey-Magni), UCL; MRC Unit for Lifelong Health and Ageing at UCL (Davis, Searle), London, UK; Division of Geriatric Medicine, Department of Medicine (Rockwood, Searle), Dalhousie University, Halifax, NS.
• CMAJ. 2020 Jan 6; 192 (1): E3-E8.

BackgroundAcutely ill and frail older adults have complex social and health care needs. It is important to understand how this complexity affects acute outcomes for admission to hospital. We validated a frailty index using routine admission laboratory tests with outcomes after patients were admitted to hospital.MethodsIn a prospective cohort of older adults admitted to a large tertiary hospital in the United Kingdom, we created a frailty index from routine admission laboratory investigations (FI-Laboratory) linked to data comprising hospital outcomes. We evaluated the association between the FI-Laboratory and total days spent in hospital, discharge to a higher level of care, readmission and mortality.ResultsOf 2552 admissions among 1750 older adults, we were able to generate FI-Laboratory values for 2254 admissions (88.3% of the cohort). More than half of admitted patients were women (55.3%) and the mean age was 84.6 (SD 14.0) years. We found that the FI-Laboratory correlated weakly with the Clinical Frailty Scale (CFS; r 2 = 0.09). An increase in the CFS and the equivalent of 3 additional abnormal laboratory test results in the FI-Laboratory, respectively, were associated with an increased proportion of inpatient days (rate ratios [RRs] 1.43, 95% confidence interval [CI] 1.35-1.52; and 1.47, 95% CI 1.41-1.54), discharge to a higher level of care (odd ratios [ORs] 1.39, 95% CI 1.27-1.52; and 1.30, 95% CI 1.16-1.47) and increased readmission rate (hazard ratios [HRs] 1.26, 95% CI 1.17-1.37; and 1.18, 95% CI 1.11-1.26). Increases in the CFS and FI-Laboratory were associated with increased mortality HRs of 1.39 (95% CI 1.28-1.51) and 1.45 (95% CI 1.37-1.54), respectively.InterpretationWe determined that FI-Laboratory, distinct from baseline frailty, could be used to predict risk of many adverse outcomes. The score is therefore a useful way to quantify the degree of acute illness in frail older adults.© 2020 Joule Inc. or its licensors.

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