Nóbrega Leandro, Pereira-Neves António, Duarte-Gamas Luís, Dias Pedro Paz, Azevedo-Cerqueira Ana, Ribeiro Hugo, Vidoedo José, Teixeira José, Rocha-Neves João
Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Ann Vasc Surg. 2022 Feb;79:153-161. doi: 10.1016/j.avsg.2021.06.049. Epub 2021 Oct 10.
Vascular surgery patients commonly have several comorbidities that cumulatively lead to a frailty status. The cumulative comorbidities disproportionately increase the risk of adverse events and are also associated with worsened long-term prognosis. In recent years, several tools have been elaborated with the objective of quantifying a patient's frailty. One of them is the modified frailty index-5 (mFI-5), a simplified and easy to use index. There is scarce data regarding its value as a prognostic factor in aortoiliac occlusive disease. The aim of this work is to validate mFI-5 as a potential postoperative prognostic indicator in this population.
From January 2013 to January 2020, 109 patients who underwent elective revascularizations, either endovascular or open surgery, having Trans-Atlantic Inter-Society Consensus II type D aortoiliac lesions in a tertiary and a regional hospital were selected from a prospective vascular registry. Demographic data was collected including diabetes mellitus, chronic heart failure, chronic obstructive pulmonary disease, arterial hypertension requiring medication and functional status. The 30-d and subsequent long-term surveillance outcomes were also collected including major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality were assessed in the 30-d post-procedure and in the subsequent long-term surveillance period. The mFI-5 was applied to this population to evaluate the prognostic impact of this frailty marker on mortality and morbidity.
In the long-term follow-up, mFI-5 was significantly associated with MACE (hazard ratio [HR] 2.469; 95% confidence interval [CI]: 1.267-4.811; P = .008) and all-cause mortality (HR 2.585; 95% CI: 1.270-5.260; P = .009). However, there was no significant association with 30-day outcomes. Along with the presence of chronic kidney disease, mFI-5 was the prognostic factor better able of predicting MACE. No prognostic value was found regarding short-term outcomes.
The mFI-5 index may have a role in predicting long term outcomes, namely MACE and all-cause mortality, in the subset of patients with extensive aortoiliac occlusive disease. Its ease of use can foster its application in risk stratification and contribute for the decision-making process.
血管外科患者通常存在多种合并症，这些合并症累积起来会导致身体虚弱。累积的合并症会不成比例地增加不良事件的风险，并且还与长期预后恶化有关。近年来，已经开发了几种工具来量化患者的虚弱程度。其中之一是改良虚弱指数-5（mFI-5），这是一个简化且易于使用的指数。关于其作为主髂动脉闭塞性疾病预后因素的价值的数据很少。这项工作的目的是验证mFI-5作为该人群潜在的术后预后指标。
从2013年1月至2020年1月，从前瞻性血管登记处选取了109例在三级和地区医院接受择期血运重建（血管内或开放手术）且患有跨大西洋血管外科学会共识II型D级主髂动脉病变的患者。收集了人口统计学数据，包括糖尿病、慢性心力衰竭、慢性阻塞性肺疾病、需要药物治疗的动脉高血压和功能状态。还收集了30天及随后的长期监测结果，包括主要不良心血管事件（MACE）、主要不良肢体事件（MALE），并在术后30天及随后的长期监测期评估全因死亡率。将mFI-5应用于该人群，以评估这种虚弱标志物对死亡率和发病率的预后影响。
在长期随访中，mFI-5与MACE（风险比[HR] 2.469；95%置信区间[CI]：1.267 - 4.811；P = 0.008）和全因死亡率（HR 2.585；95% CI：1.270 - 5.260；P = 0.009）显著相关。然而，与30天的结果没有显著关联。与慢性肾脏病的存在一起，mFI-5是更能预测MACE的预后因素。未发现其对短期结果有预后价值。
mFI-5指数可能在预测广泛主髂动脉闭塞性疾病患者亚组的长期结果，即MACE和全因死亡率方面发挥作用。其易于使用的特点可促进其在风险分层中的应用，并有助于决策过程。
