Composite Biomarkers for Assessing Frailty Status in Stable Older Adults With Cardiovascular Disease

Background: The relationship between frailty status and laboratory measurements in cardiovascular disease (CVD) remains unclear. We investigated which laboratory measurements indicated frailty in stable older CVD patients. Methods and Results: One-hundred thirty-eight stable older CVD patients were evaluated by laboratory measurements, with frailty assessed using the Kihon Checklist (KCL). Laboratory measurements were compared between frail and non-frail groups. Across the entire cohort, mean age was 81.7 years, mean left ventricular ejection fraction was 57.8%, and mean plasma B-type natriuretic peptide was 182 pg/mL. KCL scores were used to divide patients into non-frail (n=43; KCL <8) and frail (n=95; KCL >= 8) groups. Serum iron was significantly lower in the frail than non-frail group (mean [ +/- SD] 61.2 +/- 30.3 vs. 89.5 +/- 26.1 mu g/dL, respectively; P<0.001). Blood urea nitrogen (BUN; 27.3 +/- 16.5 vs. 19.7 +/- 8.2 mg/dL; P=0.013) and C-reactive protein (CRP; 1.05 +/- 1.99 vs. 0.15 +/- 0.21 mg/dL; P=0.004) were significantly higher in the frail than non-frail group. Multivariate analysis revealed that serum iron, CRP, and BUN were significant independent predictors of frailty (beta=-0.069, 0.917, and 0.086, respectively). Conclusions: Frailty status was significantly associated with iron, CRP, and BUN in stable older CVD patients. Composite biomarkers (inflammation, iron deficiency, and renal perfusion) may be useful for assessing frailty in these patients.