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We aimed, in diverse samples, to determine the optimal construction of an FI-Lab for acute care and evaluate its validity as a measure of latent health status across the adult life span.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>Our retrospective multicohort study used emergency department encounters in Boston, USA (MIMIC-IV-ED; 2011\u20132019) and London, UK (King\u2019s College Hospital (KCH); 2017\u20132020); and a community-based cohort in the UK (UK Biobank; 2006\u20132010). We evaluated FI-Lab configurations by varying test selection strategies, number of tests, and minimum test thresholds. Sensitivity analyses examined performance across age, ethnicities, sexes, and model types to identify potential blind spots. The primary outcome was 1-year all-cause mortality.<\/jats:p>\n                    <jats:p>\n                      We analysed 227,736 visits (113,032 patients) from MIMIC-IV-ED; 152,305 visits (96,843 patients) from KCH; and 492,703 UK Biobank. An FI-Lab calculated from 25 commonly ordered tests (minimum 15 required) demonstrated hazard ratios for 1-year mortality approaching those of chronological age and exceeding the National Early Warning Score 2 (NEWS2). In combined models, hazard ratios for FI-Lab per standard deviation increase were 2.04 (95 %CI [1.99, 2.09];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in MIMIC-IV-ED, 2.55 (95 %CI [2.42, 2.69];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in KCH, and 1.87 (95% CI [1.80, 1.94];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in UK Biobank. Performance was consistent across subject groupings. Discrimination plateaued at 20\u201340 tests. This was a retrospective study; future work exploring the impact on everyday use requires prospective evaluation, potentially in a randomised controlled trial.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The FI-Lab provides an automated, scalable measure of patient vulnerability that is robust across healthcare settings and populations. A core set of 20\u201340 commonly ordered tests is sufficient for signal capture. It offers a pragmatic complement to clinical judgement without requiring manual data entry or additional tests.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1005004","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:47:46Z","timestamp":1788284866000},"page":"e1005004","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the FI-Lab, a laboratory-based, automated frailty index for acute care: A multicohort study"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6428-0158","authenticated-orcid":true,"given":"Hugh","family":"Logan Ellis","sequence":"first","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Biostatistics and Health Informatics"]},{"name":"Dalhousie University","place":["Halifax, Nova Scotia, Canada"],"department":["Division of Geriatric Medicine, Department of Medicine"]},{"name":"St George's Healthcare NHS Trust","place":["London, United Kingdom"],"department":["Department of Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5828-3934","authenticated-orcid":true,"given":"Peter","family":"Hanlon","sequence":"additional","affiliation":[{"name":"University of Glasgow","place":["Glasgow, United Kingdom"],"department":["School of Health and Wellbeing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4642-9334","authenticated-orcid":true,"given":"Liam","family":"Dunnell","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital","place":["London, United Kingdom"],"department":["Department of Clinical Gerontology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2897-2026","authenticated-orcid":true,"given":"Martin","family":"Whyte","sequence":"additional","affiliation":[{"name":"Kings College Hospital","place":["London, United Kingdom"],"department":["Department of Diabetes"]},{"name":"University of Surrey","place":["Guildford, United Kingdom"],"department":["School of Biosciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H. J.","family":"Davis","sequence":"additional","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Institute of Health Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9396-1972","authenticated-orcid":true,"given":"Josephine","family":"Bates","sequence":"additional","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Faculty of Life Sciences & Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1280-8506","authenticated-orcid":true,"given":"Adeel","family":"Jafri","sequence":"additional","affiliation":[{"name":"Western General Hospital","place":["Edinburgh, United Kingdom"],"department":["Oncology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2434-3641","authenticated-orcid":true,"given":"Diana","family":"Shamsutdinova","sequence":"additional","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Biostatistics and Health Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-8319","authenticated-orcid":true,"given":"James T.","family":"Teo","sequence":"additional","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Biostatistics and Health Informatics"]},{"name":"King\u2019s College Hospital","place":["London, United Kingdom"],"department":["Department of Neurology"]},{"name":"Cleveland Clinic Hospital London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-2727","authenticated-orcid":true,"given":"Zina","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Biostatistics and Health Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-995X","authenticated-orcid":true,"given":"Kenneth","family":"Rockwood","sequence":"additional","affiliation":[{"name":"Dalhousie University","place":["Halifax, Nova Scotia, Canada"],"department":["Division of Geriatric Medicine, Department of Medicine"]},{"name":"Nova Scotia Health","place":["Halifax, Nova Scotia, Canada"],"department":["Centre for Health Care of the Elderly"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"1","key":"pmed.1005004.ref001","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1186\/s12916-024-03572-z","article-title":"Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? 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