A Simple Frailty Index Predicts in-hospital Mortality

INTRODUCTION A frailty model that predicts in-hospital mortality is important to compare different settings and perhaps to modify patient disposition and treatment. We attempt to determine (a) if a new scale (Laniado-4 scale) that includes only three yes/no questions derived from the Norton scale and the presence of a urinary catheter performs as well as the graded Norton scale (including all five domains), in predicting in-hospital mortality and (b) to determine the predictive value of a simple frailty index that includes the new scale as well as categories of age, serum albumin, and creatinine values. METHODS: The study cohort included all acutely admitted adult patients in 2020–2021 to the three internal medicine departments at a regional 400-bed hospital. We calculated odds ratios with 95% confidence intervals and c-statistics for the various models predicting in-hospital mortality. RESULTS: The mean patient age was 73 ± 19 years, and 49.1% (5665/11542) were males. The Laniado-4 scale performed better than the Norton scale for predicting in-hospital mortality. A simple frailty index ranging from 0 to ≥ 8 points was associated with rates of in-hospital mortality that increased from 0 to 37.7%, with an odds ratio of 2.13(2.03–2.25) per 1 index point. The c-statistic was 0.887(0.881–0.893). CONCLUSIONS. We conclude the Laniado-4 scale performed better than the Norton scale in predicting in-hospital mortality, and that a simple frailty index including the 4-question scale as well as categories of age, serum creatinine, and serum albumin performed as well or better than more complicated models.