{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:46:29Z","timestamp":1785833189537,"version":"3.56.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recurrent hospitalizations and mortality are frequent among frail older adults, reflecting reduced physiological reserve and vulnerability to stressors. Identifying inexpensive and readily available biomarkers for risk stratification remains a priority in geriatric medicine. The Fibrosis\u20104 (FIB\u20104) index, originally developed to estimate liver fibrosis, has recently emerged as a systemic risk marker beyond hepatic disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational study including 248 hospitalized patients aged \u2265\u200970\u2009years admitted to an internal medicine department. Frailty was assessed using the Frailty Index (FI), which was calculated at hospital admission. The primary composite endpoint was all\u2010cause mortality or unplanned hospital readmission during follow\u2010up (mean 159\u2009\u00b1\u2009128\u2009days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants were categorized as low FIB\u20104 (&lt;\u20091.3,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953) or intermediate\u2013high FIB\u20104 (\u2265\u20091.3,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009195). Individuals with FIB\u20104\u2009\u2265\u20091.3 showed higher inflammatory burden (increased C\u2010reactive protein), lower nutritional reserve (reduced pre\u2010albumin), higher D\u2010dimer levels, and longer hospital stay. During follow\u2010up, 128 events occurred (39 deaths and 89 readmissions). FIB\u20104\u2009\u2265\u20091.3 was associated with increased risk of the composite endpoint (HR 2.268, 95% CI 1.210\u20134.252,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). After adjustment for sex, smoking status, BMI, and frailty index, FIB\u20104 remained independently associated with adverse outcomes (HR 2.045, 95% CI 1.206\u20134.199,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FIB\u20104 appears to reflect reduced biological reserve and systemic vulnerability rather than isolated liver dysfunction. As a cost\u2010free parameter derived from routine blood tests, FIB\u20104 may represent a practical tool for risk stratification in hospitalized frail older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70629","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:19:30Z","timestamp":1785831570000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Hospital Readmission and Mortality Risk in Older Frail Patients Using the\n                    <scp>FIB<\/scp>\n                    \u20104 Index: A Cohort Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5496-4890","authenticated-orcid":false,"given":"Stefano","family":"Rizza","sequence":"first","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Ferrazza","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Postorino","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Quatrana","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Martina","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Nucera","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Federici","sequence":"additional","affiliation":[{"name":"Department of System Medicine University of Rome Tor Vergata  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"\u201cWorld Population Prospects 2022 Online Edition \u201d(2022) The aging rate of various countries in Europe the US and Asia (Source: United Nations Department of Economic and Social Affairs Population Division)."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)00812\u20102"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1421"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1212324"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.091117"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e13323"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1042\/CS20130036","article-title":"Non\u2010Alcoholic Fatty Liver Disease Is Associated With an Increased Prevalence of Atrial Fibrillation in Hospitalized Patients With Type 2 Diabetes","volume":"125","author":"Targher G.","year":"2013","journal-title":"Clinical Science"},{"key":"e_1_2_12_9_1","first-page":"879","article-title":"Heart Valve Calcification in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease","volume":"64","author":"Mantovani A.","year":"2015","journal-title":"MetabolismClinical and Experimental"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.jhep.2017.12.012","article-title":"Association Between Non\u2010Alcoholic Fatty Liver Disease and Subclinical Coronary Atherosclerosis: An Observational Cohort Study","volume":"68","author":"Lee S. 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