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Updated: Jan 2, 2026
Frailty Assessment in an Aging Mouse Model
Published on: September 23, 2025
An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical
R Starkman1, S Alibhai2, R A Wells1
1Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Abstract:
The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.
Insights
The frailty index (FI) improves risk prediction for myelodysplastic syndromes (MDS). This tool helps refine prognostication by assessing patient deficits, enhancing survival outcome predictions.
Area of Science:
- Gerontology
- Hematology
- Clinical Medicine
Background:
- The frailty index (FI) quantifies health deficits to predict adverse outcomes.
- Myelodysplastic syndromes (MDS) require accurate prognostic tools for patient management.
Purpose of the Study:
- To develop and validate a MDS-specific FI (MDS-FI) using a prospective registry.
- To assess the prognostic power of the MDS-FI in addition to conventional scores.
Main Methods:
- Developed an MDS-FI incorporating 42 deficits (physical, comorbidities, ADLs, QoL, performance status).
- Calculated FI for 440 eligible patients from a prospective MDS registry (644 total patients).
- Assessed FI correlation with age, IPSS/IPSS-R, and overall survival (OS) via multivariate analysis.
Main Results:
- Median FI was 0.25; correlated with age and IPSS/IPSS-R.
- MDS-FI significantly predicted OS, with a 37% incremental discrimination improvement.
- Multivariate analysis identified age >70, FI, transfusion dependence, and IPSS as significant OS covariates.
Conclusions:
- The MDS-FI demonstrates prognostic value, enhancing existing risk stratification models for MDS.
- A derived prognostic score created five distinct risk groups with varying survival outcomes.
- External validation of the MDS-FI is recommended for clinical application in refining MDS prognostication.
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