临床虚弱与肢体威胁严重程度及慢性肢体威胁性缺血结局的关联。
Associations of Clinical Frailty with Severity of Limb Threat and Outcomes in Chronic Limb-threatening Ischaemia.
机构信息
Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK.
Department of Cardiovascular Sciences, University of Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK.
出版信息
Ann Vasc Surg. 2021 Oct;76:406-416. doi: 10.1016/j.avsg.2021.04.017. Epub 2021 May 2.
OBJECTIVE
Investigate the relationship of frailty and severity of chronic limb-threatening ischaemia (CLTI), and their comparative associations with one-year outcomes, in patients presenting to a vascular limb salvage (VaLS) clinic.
METHODS
This retrospective cohort study utilised data collected from a prospectively maintained VaLS clinic database. Patients aged ≥50 presenting to the VaLS clinic with CLTI between February 2018 and April 2019 were included. Frailty was measured using the Clinical Frailty Scale (CFS) and limb threat severity by the Wound, Ischaemia, and foot Infection (WIfI) score. Excessive polypharmacy was defined as ≥10 medications. Anticholinergic burden (ACB) score and Charlson comorbidity index (CCI) were calculated for all patients. The primary outcome measure was a composite endpoint of death or amputation at one-year. Associations with outcome were assessed using Cox regression and reported as hazards ratios (HR) with 95% confidence intervals (CI).
RESULTS
A total of 198 patients were included, with CFS scores available for 190 patients. 98 patients (52%) were frail (CFS ≥5). 127 patients (67%) initially underwent endovascular revascularisation. Excessive polypharmacy was common (55 patients; 28%). Frailty was associated with increased WIfI stage (P = 0.025) as well as age, female sex, CCI score, number of medications, excessive polypharmacy but not ACB score. Frail patients were more frequently managed non-operatively (P = 0.017). Frailty (HR 1.91; 95% CI 1.09, 3.34; P = 0.024) and WIfI stage 4 (HR 3.29; 95%CI 1.23, 8.80; P = 0.018) were associated with death or amputation on univariable analysis. WIfI stage 4 (HR 2.80; 95%CI 1.04, 7.57; P = 0.042) and CCI score (HR 1.21; 95%CI 1.03, 1.41; P = 0.015), but not frailty (HR 1.25; 95%CI 0.67, 2.33; P = 0.474), were independently associated with death or amputation on multivariable analysis.
CONCLUSIONS
Frailty is highly prevalent among CLTI patients and related to severity of limb threat. The CFS may be a useful adjunct to patient risk assessment in CLTI.
目的
调查衰弱与慢性肢体威胁性缺血（CLTI）严重程度的关系，并在血管肢体挽救（VaLS）诊所就诊的患者中比较它们与一年结局的关系。
方法
本回顾性队列研究利用前瞻性维护的 VaLS 诊所数据库中收集的数据。2018 年 2 月至 2019 年 4 月，年龄≥50 岁且在 VaLS 诊所因 CLTI 就诊的患者被纳入研究。使用临床虚弱量表（CFS）评估虚弱程度，使用伤口、缺血和足部感染（WIfI）评分评估肢体威胁严重程度。过度用药定义为≥10 种药物。为所有患者计算抗胆碱能药物负担（ACB）评分和 Charlson 合并症指数（CCI）。主要结局测量指标为一年时死亡或截肢的复合终点。使用 Cox 回归评估与结局的关联，并以 95%置信区间（CI）报告风险比（HR）。
结果
共纳入 198 例患者，其中 190 例患者的 CFS 评分可用。98 例（52%）患者虚弱（CFS≥5）。127 例（67%）患者最初接受了血管内血运重建。过度用药很常见（55 例；28%）。虚弱与较高的 WIfI 分期（P=0.025）以及年龄、女性、CCI 评分、药物数量、过度用药有关，但与 ACB 评分无关。虚弱患者更常接受非手术治疗（P=0.017）。在单变量分析中，虚弱（HR 1.91；95%CI 1.09，3.34；P=0.024）和 WIfI 4 期（HR 3.29；95%CI 1.23，8.80；P=0.018）与死亡或截肢相关。WIfI 4 期（HR 2.80；95%CI 1.04，7.57；P=0.042）和 CCI 评分（HR 1.21；95%CI 1.03，1.41；P=0.015），而不是虚弱（HR 1.25；95%CI 0.67，2.33；P=0.474），在多变量分析中与死亡或截肢相关。
结论
虚弱在 CLTI 患者中很常见，与肢体威胁的严重程度相关。CFS 可能是 CLTI 患者风险评估的有用辅助手段。
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