Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.
National University Hospital, Singapore, Singapore.
Vascular. 2022 Feb;30(1):42-51. doi: 10.1177/1708538120988228. Epub 2021 Jan 24.
The aim was to evaluate the utility of frailty, as defined by the modified Frailty Index-1 1 (mFI-11) on predicting outcomes following endovascular revascularisation in Asian patients with chronic limb-threatening ischaemia (CLTI).
CLTI patients who underwent endovascular revascularisation between January 2015 and March 2017 were included. Patients were retrospectively scored using the mFI-11 to categorise frailty as low, medium or high risk. Observed outcomes included 30-day complication rate and unplanned readmissions, 1-, 6- and 12-month mortality, and ambulation status at 6- and 12 months post-intervention.
A total of 233 patients (250 procedures) were included; 137 (58.8%) were males and the mean age was 69.0 (±10.7) years. 202/233 (86.7%) were diabetic and 196/233 (84.1%) had a prior diagnosis of peripheral arterial disease (PAD). The mean mFI-11 score was 4.2 (±1.5). 28/233 (12.0%), 155/233 (66.5%), and 50/233 (21.5%) patients were deemed low (mF-11 score 0-2), moderate (mFI-11 score 3-5) and high (mFI-11 score 5-7) frailty risk, respectively. High frailty was associated with an increased 12-month mortality (OR 8.54, 95% CI 1.05-69.5; = 0.05), 30-day complication rate (OR 9.41, 95% CI 2.01-44.1; < 0.01) and 30-day unplanned readmission (OR 5.06, 95% CI 1.06-24.2; = 0.04). Furthermore, a high score was associated with a significantly worse 6- (OR 0.320, 95% CI 0.120-0.840; = 0.02) and 12-month (OR 0.270, 95% CI 0.100-0.710; < 0.01) ambulatory status.
The mFI-11 is a useful, non-invasive tool that can be readily calculated using readily available patient data, for prediction of medium-term outcomes for Asian CLTI patients following endovascular revascularisation. Early recognition of short- and mid-term loss of ambulation status amongst high-frailty patients in this challenging cohort of patients could aid decision-making for whether a revascularisation or amputation-first policy is appropriate, and manage patient and caregiver expectations on potential improvement in functional outcome.
本研究旨在评估改良 frailty index-11（mFI-11）在预测亚洲慢性肢体威胁性缺血（CLTI）患者血管内血运重建术后结局中的作用。
纳入 2015 年 1 月至 2017 年 3 月间接受血管内血运重建术的 CLTI 患者。采用 mFI-11 对患者进行回顾性评分，将 frailty 分为低危、中危和高危。观察结局包括 30 天并发症发生率和非计划再入院率、1、6 和 12 个月死亡率以及干预后 6 和 12 个月的步行状态。
共纳入 233 例（250 例手术）患者；其中 137 例（58.8%）为男性，平均年龄为 69.0（±10.7）岁。202/233（86.7%）例患者为糖尿病患者，196/233（84.1%）例患者有外周动脉疾病（PAD）既往史。平均 mFI-11 评分为 4.2（±1.5）。28/233（12.0%）、155/233（66.5%）和 50/233（21.5%）例患者被认为 frailty 风险低（mFI-11 评分 0-2）、中（mFI-11 评分 3-5）和高（mFI-11 评分 5-7）。高 frailty 与 12 个月死亡率增加（OR 8.54，95%CI 1.05-69.5； = 0.05）、30 天并发症发生率（OR 9.41，95%CI 2.01-44.1； < 0.01）和 30 天非计划再入院率（OR 5.06，95%CI 1.06-24.2； = 0.04）相关。此外，高评分与 6 个月（OR 0.320，95%CI 0.120-0.840； = 0.02）和 12 个月（OR 0.270，95%CI 0.100-0.710； < 0.01）较差的步行状态显著相关。
mFI-11 是一种有用的、非侵入性工具，可通过使用易于获得的患者数据轻松计算，用于预测亚洲 CLTI 患者血管内血运重建术后的中期结局。在这一具有挑战性的 CLTI 患者队列中，早期识别高 frailty 患者的短期和中期步行状态丧失，有助于确定血运重建或截肢的治疗策略，管理患者和照护者对潜在功能改善的期望。
