Comparison of malnutrition and frailty scales with laboratory parameters in geriatric age group patients presenting to the emergency department

Aim: The definition that affects the quality of life of the elderly and forms the basis of the problems brought by old age is geriatric syndromes. Among geriatric syndromes, frailty and malnutrition are thought to be the most important factors in increasing morbidity and mortality, prolonged hospital stay, health expenditures, and increasing need for elderly care. In this study, we aimed to evaluate the use of objective, accessible and reproducible laboratory tests to predict clinical outcomes early, as well as the scales used to assess malnutrition and frailty. Materials and Methods: We conducted a prospective single-center study with 106 patients aged 65 and over who applied to the Adult Emergency Service of Ankara University Faculty of Medicine between 01.09.2022 and 01.11.2022. Patients with advanced Alzheimer's/dementia, malignancy requiring active treatment (CT, RT), immobile patients, and multiple trauma patients were not included in the study. Demographic information of the patients, drugs they use, alcohol/smoking habits, and comorbid diseases were questioned and Charlson Comorbidity Index (CCI) was calculated. Modified Frailty Index (mFI), FRAILTY Index (FI), and Clinical Frailty Score (CFS) scales were calculated for the frailty status of the patients, and Mini Nutritional Assessment Short Form (MNA-SF) was used to determine their malnutrition status. Blood parameters including prealbumin, iron, fasting insulin, HgA1c, vitamin B12, and parathormone (PTH) parameters were studied in all patients. The clinical outcomes of the patients were evaluated as discharge from the emergency department, admission to the service and intensive care unit, and 30-day mortality. In comparisons between groups, chi-square or Fisher's exact test for categorical variables, Student's t test for continuous variables or post-hoc Tukey test with one-way analysis of variance, Mann Whitney U or Kruskal Wallis for non-normally distributed and ordinal variables analysis of variance was used. Results: Different frailty rates were determined according to MFI, FI, and CFS scores of 106 patients included in the study (10.4%, 67.9%, and 87.7%, respectively). According to MNA-SF, 18.9% of the patients were malnourished and 47.2% were at risk for malnutrition. It was determined that as the CCI score increased, the duration of hospitalization increased (p<0.001), and the probability of hospitalization increased (p=0.011). It was determined that as fragility and malnutrition increased, length of hospital stay and poor prognosis increased, and hemoglobin, prealbumin, albumin, and total protein values decreased (p<0.05). Fasting insulin (p=0.001) was decreased in malnourished patients, and vitamin B12 was found highed in frail patients. Decreased prealbumin, albumin, total protein, and hemoglobin were found to help predict discharge, hospitalization, or mortality. In addition, increased levels of vitamin B12 (p=0.026), d-dimer (p=0.024), PTH (p=0.033), neutrophil-lymphocyte ratio (NLR) (p=0.017), and creatinine (p=0.001), and decrease in the calcium (Ca) value (p=0.018) negatively affected the clinical outcomes of the patients. Conclusion: The combined use of easily accessible blood parameters such as albumin, prealbumin, and total protein, as well as frailty and malnutrition scores in geriatric patients, admitted to the emergency department, can help predict the clinical outcomes of the patients. In terms of prognosis evaluation, combination models with blood parameters can be planned instead of using scores alone due to the difference between the scorings used. Thus, it will contribute to the increase in the healthy elderly population, the decrease in the morbidity and mortality of the elderly, and the more efficient use of health care resources. Therefore, we think that our study may help future studies with frail and malnourished elderly population. Keywords: Aging, Frailty, Malnutrition, Frailty Scales, Geriatric Syndromes, Total protein