Assmann Patricia, Kievit Peter, van der Wulp Kees, Verkroost Michel, Noyez Luc, Bor Hans, Schoon Yvonne
Department of Primary and Elderly Care, Radboud University Medical Centre Nijmegen, The Netherlands; ZZG Care Group, Nijmegen, The Netherlands.
Department of Cardiology , Radboud University Medical Centre Nijmegen , The Netherlands.
Open Heart. 2016 Dec 12;3(2):e000478. doi: 10.1136/openhrt-2016-000478. eCollection 2016.
We hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI).
Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively.
Incidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R=0.271, Frailty Index and EuroSCORE II were independently associated with mortality.
Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI.
我们假设衰弱评估对于预测经导管主动脉瓣植入术（TAVI）后的谵妄和死亡率具有额外价值。
对89例连续接受TAVI的患者进行观察性研究。纳入时间为2012年11月至2014年2月，随访至2014年4月。分别测量衰弱评估和心脏评估中的变量与TAVI后谵妄和死亡率之间的关联。
TAVI后谵妄的发生率：25/89（28%）。与谵妄呈保护性关联的衰弱评估变量有：简易精神状态检查表（比值比[OR]0.79；95%置信区间[CI]0.65至0.96；p = 0.02）、日常生活活动能力（OR 0.79；95% CI 0.63至0.99；p = 0.04）和步速（OR 0.05；95% CI 0.01至0.50；p = 0.01）。起立行走测试与谵妄呈预测性关联（OR 1.14；95% CI 1.03至1.26；p = 0.01）。在心脏评估中，肺动脉高压与谵妄呈保护性关联（OR 0.34；95% CI 0.12至0.98；p = 0.05）。多因素逻辑回归分析：Nagelkerke R = 0.359，简易精神状态检查表与谵妄独立相关。死亡率：11/89（12%）。与死亡率呈预测性关联的变量有：衰弱指数总分（风险比[HR]1.66，95% CI 1.06至2.60；p = 0.03）、欧洲心脏手术风险评估系统（EuroSCORE）II（HR 1.14，95% CI 1.06至1.22；p < 0.001）和并发症（HR 4.81，95% CI 1.03至22.38；p = 0.05）。多因素Cox比例风险分析：Nagelkerke R = 0.271，衰弱指数和EuroSCORE II与死亡率独立相关。
TAVI后谵妄经常发生。衰弱评估中的变量与谵妄和死亡率相关，独立于心脏评估。因此，衰弱评估在预测TAVI后的谵妄和死亡率方面可能具有额外价值。
