Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2021 Feb;111(2):586-593. doi: 10.1016/j.athoracsur.2020.05.072. Epub 2020 Jul 3.
Although frailty has been previously shown to negatively influence postoperative outcomes, frailty measurements remain undefined and underused for patients undergoing orthotopic heart transplantation (OHT). This study aims to derive and validate an OHT frailty screening tool.
The United Network for Organ Sharing database was queried for adults undergoing OHT between 2000 and 2018. The total population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome was mortality. Secondary outcomes included rates of major morbidities and hospital length of stay. Variables that were constructs within preexisting frailty tools and that were predictive of a composite frailty outcome within the derivation cohort were incorporated into a multivariable regression model (exploratory, P < .2). Independent predictors of frailty were included in the OHT frailty screening tool.
A total of 36,790 OHT recipients met the criteria for inclusion. Twelve variables were identified as independent predictors of frailty and included as OHT frailty screening tool constructs. Recipients in the validation cohort were stratified as nonfrail (72.9%, n = 5363), prefrail (24.4%, n = 1795), and frail (2.7%, n = 200). Frail patients had significantly higher rates of posttransplant stroke, renal failure, and mortality at all time intervals as well as longer length of stay (all P < .001). The risk model's predictive rates of mortality strongly correlated with the observed rates of mortality (r = 0.97, P < .001). The c-index of the OHT frailty score was 0.74.
The OHT frailty screening tool is highly predictive of adverse posttransplant outcomes. This screening tool may provide a framework to enhance existing risk stratification tools and improve overall resource utilization.
尽管虚弱先前已被证明会对术后结果产生负面影响，但对于接受原位心脏移植（OHT）的患者，虚弱测量仍未得到明确和充分利用。本研究旨在制定和验证 OHT 虚弱筛查工具。
利用 United Network for Organ Sharing 数据库查询 2000 年至 2018 年期间接受 OHT 的成年人。将总人群随机分为推导（80%）和验证（20%）队列。主要结局是死亡率。次要结局包括主要发病率和住院时间长度。在推导队列中，纳入那些是现有虚弱工具的组成部分且预测复合虚弱结果的变量，纳入多变量回归模型（探索性，P <.2）。将 OHT 虚弱筛查工具中包含独立预测虚弱的变量。
共有 36790 名 OHT 受者符合纳入标准。确定了 12 个变量作为虚弱的独立预测因素，并将其纳入 OHT 虚弱筛查工具的构建中。验证队列中的受者分为非虚弱（72.9%，n = 5363）、虚弱前期（24.4%，n = 1795）和虚弱（2.7%，n = 200）。虚弱患者在所有时间间隔的移植后中风、肾衰竭和死亡率以及住院时间长度均显著较高（均 P <.001）。风险模型的死亡率预测率与观察到的死亡率强烈相关（r = 0.97，P <.001）。OHT 虚弱评分的 C 指数为 0.74。
OHT 虚弱筛查工具对不良移植后结局具有高度预测性。这种筛查工具可能为增强现有的风险分层工具和提高整体资源利用率提供框架。
