Development, validation and performance of laboratory frailty indices: A scoping review

Faisal F Hakeem; Asri Maharani; Chris Todd; Terence W O'Neill

doi:10.1016/j.archger.2023.104995

Development, validation and performance of laboratory frailty indices: A scoping review

Arch Gerontol Geriatr. 2023 Aug:111:104995. doi: 10.1016/j.archger.2023.104995. Epub 2023 Mar 11.

Authors

Faisal F Hakeem¹, Asri Maharani², Chris Todd³, Terence W O'Neill⁴

Affiliations

¹ Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia; Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK. Electronic address: fhakeem@taibahu.edu.sa.
² Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK; Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK.
³ School of Health Sciences, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Applied Research Collaboration- Greater Manchester, Manchester, UK.
⁴ Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK.

PMID: 36963345
DOI: 10.1016/j.archger.2023.104995

Abstract

Introduction: Frailty is a syndrome characterised by decline in functional ability and increasing vulnerability to disease and associated with adverse outcomes. Several established methods exist for assessing frailty. This scoping review aims to characterise the development and validation of frailty indices based on laboratory test results (FI-Lab) and to assess their utility.

Methods: Studies were included in the review if they included data concerning the development and/or testing an FI-Lab using the deficit accumulation method. Studies were identified using PubMed/MEDLINE, Embase (Elsevier), OpenGrey and Google Scholar from 2010 to 2021. Two reviewers independently screened all abstracts, and those that met the inclusion criteria were reviewed in detail. Data extracted included details about the study characteristics, number, type and coding of laboratory variables included, validation, and outcomes. A narrative synthesis of the available evidence was adopted.

Results: The search yielded 915 articles, of which 29 studies were included. In general, 89% of studies were conducted after 2016 and 51% in a hospital-based setting. The number of variables included in FI-Labs ranged from 13 to 77, and 51% included some non-laboratory variables in their indices, with pulse and blood pressure being the most frequent. The validity of FI-Lab was demonstrated through change with age, correlation with established frailty indices and association with adverse health outcomes. The most frequent outcome studied was mortality (79% of the studies), with FI-Lab associated with increased mortality in all but one. Other outcomes studied included self-reported health, institutionalisation, and activities of daily living. The effect of combining the FI-Lab with a non-laboratory-based FI was assessed in 7 studies with a marginal increase in predictive ability.

Conclusion: Frailty indices constructed based on the assessment of laboratory variables, appear to be a valid measure of frailty and robust to the choice of variables included.

Keywords: Frailty; Frailty index; Laboratory tests; Outcomes; Validity.

Publication types

Review

MeSH terms

Activities of Daily Living
Aged
Frail Elderly
Frailty* / diagnosis
Geriatric Assessment / methods
Humans
Self Report