Uji Diskriminasi dan Kalibrasi Clinical Frailty Scale sebagai Prediktor Mortalitas 30 Hari pada Pasien Lanjut Usia di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Background: an elderly who is hospitalized has a considerable prevalence of frailty which is around 27-80%. an elderly who is hospitalized has a greater risk of mortality in frailty individuals than non-frailty individuals. The Clinical Frailty Scale (CFS) is a scale or tool for clinical assessment of frailty developed by The Canadian Study of Health and Aging (CSHA). The CFS is widely applicable and easy to use in a variety of settings and can assess a wide range of clinical outcomes in the care of the elderly population. The CFS has also become the most meaningful and frequently used to assess the motality prognosis of elderly patients. The aim of this study was to assess the discrimination performance or validity of CFS as a predictor of 30-day mortality in hospitalized elderly patients. Methods: This study is a prospective cohort study with research subjects of patients aged ≥ 60 years who were admitted to H. Adam Malik Medan Hospital in September - October 2023. The primary outcome assessed was patient mortality within 30 days. CFS discrimination performance was assessed using area under the curve (AUC). Calibration performance was assessed using the Hosmer-Lemeshow test. The secondary outcome was to determine the factors that played a role in 30-day mortality. Independent variables in this study were analyzed by bivariate and multivariate (multiple logistic regression) using the SPSS program. Results: 120 patients participated in this study with a mortality rate of 43.3%. Calibration performance was shown by the Hosmer-Lemeshow test with a p value = 0.661. CFS discrimination performance was shown by the ROC curve with an AUC value of 83.2% (95% CI 76% - 90.4%). The results of secondary outcomes analyzed by logistic regression there are 3 independent variables that most dominantly affect 30-day mortality, namely CRP (95% CI 1.607 - 11.302); CFS (95% CI 1.428 - 11.497) and nutritional status. Conclusion: CFS showed good calibration and discrimination performance in predicting 30-day mortality of elderly patients admitted to H. Adam Malik Hospital Medan. There are 3 variables that most dominantly affect the occurrence of 30-day mortality, namely CRP levels > 1 mg/dL, CFS score ≥ 7 and malnutrition