Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study

PURPOSE: Frailty is gaining increased recognition in the evaluation of lung transplant (LTx) candidates. The Fried Frailty Phenotype (FFP) index has been the most commonly used instrument and is associated with pre- and post-transplant morbidity and mortality. A novel, alternative approach to assessing frailty is the Cumulative Deficits Frailty Index (CFI), which evaluates health deficits across multiple domains that may aid in refining candidacy evaluation. As a preliminary assessment, we aimed to understand the distribution of frailty scores among LTx candidates and assess agreement between the FFP and the CFI. METHODS: This was a prospective, multi-center study of a subset of participants in the Clinical Trials in Organ Transplantation-20 cohort who completed both the FFP and CFI assessments pre-transplant. FFP was characterized using 5 criteria (unintentional weight loss, grip strength, energy levels, gait speed and physical activity), with FFP frailty defined (≥3 criteria frail; 1-2 pre-frail; and 0 not frail). The CFI was comprised of 40 health items abstracted from medical records with frailty defined as >10/40 (score of 0.25) deficits. Agreement between total FFP and CFI scores was assessed using Cohen's Kappa statistic and we also evaluated the distribution of CFI scores by each sub-component of the FFP. RESULTS: The cohort was comprised of 124 LTx candidates (median age 62 years, 56% male, median LAS 39) with 57% having restrictive lung disease. 11 (9%) LTx candidates were frail on the FFP, whereas 85 (69%) were pre-frail (grouped as non-frail). The median CFI score for the cohort was 0.23 (IQR 0.15-0.28) with 48 (39%) deemed frail. 79 (64%) had matching frail and non-frail statuses between the indices with agreement assessed as poor [Kappa 0.11 95% CI (-0.02 to 0.24)]. The median CFI scores were more concordant with FFP domains of weight loss [Frail FFP: 0.26 (IQR 0.20-0.29) vs. Not Frail FFP: 0.21 (0.15-0.28)], physical activity [0.25 (0.21-0.28) vs. 0.21 (0.15-0.28)], and gait speed [0.25 (0.19-0.33) vs. 0.21 (0.15-0.28)], but not with grip strength or energy levels. CONCLUSION: In this multi-center study, agreement between frailty indices was poor suggesting the CFI potentially captures a different construct than FFP. The study is ongoing evaluating the prognostic utility of these indices with early post-transplant outcomes.

Duke Scholars

Author Megan Lee Neely Biostatistics & Bioinformatics, Division of Biostatistics

Author Jeremy Weber  

Author Jamie Lynn Todd Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author John Michael Reynolds Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Scott Michael Palmer Jr. Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Laurie D. Snyder Medicine, Pulmonary, Allergy, and Critical Care Medicine