title: An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals.
abstract: BACKGROUND
  Frailty is a geriatric syndrome of decreased physiologic reserve and a risk factor for hospitalization and mortality. We hypothesized that an adapted survey-based frailty-related phenotype (aFRP) predicts hospitalization and mortality among HIV-infected and uninfected individuals in adjusted models but is uncommon among those achieving undetectable HIV-1 RNA.
  
  
  METHODS
  Defined from self-reported domains of physical shrinking, exhaustion, slowness, and low physical activity in Veterans Aging Cohort Study (VACS) participants, aFRP was considered present with ≥3 domains and prefrailty with 1-2 domains. Cox survival analysis determined hazard ratios (HRs) for 5-year hospitalization and mortality risk adjusting for frailty states, demographics, health behaviors, comorbidities, and a validated risk index incorporating HIV-specific and general organ system biomarkers, the VACS Index. Model discrimination was assessed.
  
  
  RESULTS
  Participants with complete data were included [6515/7324 (89%)]. Of these, 3.9% of HIV-infected individuals with HIV-1 RNA >400 copies per milliliter; 2.0% of HIV-infected individuals with HIV-1 RNA ≤400 copies per milliliter; and 2.8% of uninfected individuals met aFRP criteria (P = 0.01). After adjustment for other covariates, aFRP was associated with hospitalization (HR = 1.78; 95% confidence interval: 1.48 to 2.13) and mortality (HR = 1.75; 95% confidence interval: 1.28 to 2.40). C-statistics for the VACS Index for hospitalization (0.633) and for mortality (0.756) were higher than for aFRP (0.565 and 0.584, respectively). C-statistic for hospitalization improved modestly when VACS Index and aFRP were both included (0.646) and minimally for mortality (0.761).
  
  
  CONCLUSIONS
  aFRP was independently associated with adverse health outcomes among HIV-infected and uninfected individuals. aFRP modestly improved prediction for hospitalization. However, the aFRP is rare among HIV-infected individuals with undetectable HIV-1 RNA.
authors.affiliation: *Department of Internal Medicine and General Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; †Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‡Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; §Department of Medicine, University of Washington School of Medicine, Seattle, WA; ‖Institute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, NJ; ¶Department of Medicine, VA Greater Los Angeles Healthcare System, UCLA School of Medicine, Los Angeles, CA; #Yale School of Nursing, New Haven, CT; **Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD; and ††Department of Medicine, VA Maryland Health Care System, University of Maryland SOM, Baltimore, MD.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: Janet P
authors.initials: JP
authors.lastname: Tate
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.forename: Julie
authors.initials: J
authors.lastname: Womack
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Krisann K
authors.initials: KK
authors.lastname: Oursler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D015658:HIV Infections / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010641:Phenotype; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data; D019562:Viral Load / Q000706:statistics & numerical data