Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple
physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month
and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a
prospective multicentre cohort study.
Methods and Findings: On 2033 hospitalized patients aged $65 years from twenty Italian geriatric units, we calculated the
frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD),
based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall
mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly
associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC)
curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect,
showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas
under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p,0.0001) and one year of followup
(areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p,0.0001). The MPI
showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients
without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high
number of drugs.
Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI
demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.
