Abstract
Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.
Highlights
For the elderly population, the assessment and definition of frailty are still under development and are debated in the literature [1,2]
Some authors searched for the impact of frailty in sub-populations included in the realm of the general internal medicine: Uchmanowicz and co. investigated the frailty syndrome and its association and impact on arterial hypertension [3]; Abdel-Kader and co. investigated the frailty following acute kidney injury [4], Abel and Klepin proposed frailty assessment to replace the patients’ age as a predictor of responses to therapy in various hematologic malignancies [5]
When all study participants were divided to three groups according to their ALT levels on admission; (below IU/L; (n = 18, to IU/L; (n = 99) and above IU/L; (n = 62); the lowest cut-off value was pointed according to the study by Gringauz, Weismann and Justo et al [9]), we found that there was a statistically significant difference in the rate of mortality: 4 patients died within the group pf ALJ.TCl IU/L only 2 patients died (Figure 2; p = 0.042)
Summary
The assessment and definition of frailty are still under development and are debated in the literature [1,2]. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results correlate with each other. When all study participants were divided to three groups according to their ALT levels on admission; (below IU/L; (n = 18, to IU/L; (n = 99) and above IU/L; (n = 62); the lowest cut-off value was pointed according to the study by Gringauz, Weismann and Justo et al [9]), we found that there was a statistically significant difference in the rate of mortality: 4 patients died within the group pf ALJ.TCl
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