Laux Magdalena L, Braun Christian, Schröter Filip, Weber Daniela, Moldasheva Aiman, Grune Tilman, Ostovar Roya, Hartrumpf Martin, Albes Johannes Maximilian
Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, 16321 Bernau, Germany.
Department of Molecular Toxicology, German Institute of Human Nutrition (DIfE), 14558 Nuthetal, Germany.
J Clin Med. 2023 Apr 20;12(8):3010. doi: 10.3390/jcm12083010.
Frailty is gaining importance in cardiothoracic surgery and is a risk factor for adverse outcomes and mortality. Various frailty scores have since been developed, but there is no consensus which to use for cardiac surgery.
In an all-comer prospective study of patients presenting for cardiac surgery, we assessed frailty and analyzed complication rates in hospital and 1-year mortality, as well as laboratory markers before and after surgery.
246 included patients were analyzed. A total of 16 patients (6.5%) were frail, and 130 patients (52.85%) were pre-frail, summarized in the frail group (FRAIL) and compared to the non-frail patients (NON-FRAIL). The mean age was 66.5 ± 9.05 years, 21.14% female. The in-hospital mortality rate was 4.88% and the 1-year mortality rate was 6.1%. FRAIL patients stayed longer in hospital (FRAIL 15.53 ± 8.5 days vs. NON-FRAIL 13.71 ± 8.94 days, = 0.004) and in intensive/intermediate care units (ITS/IMC) (FRAIL 5.4 ± 4.33 days vs. NON-FRAIL 4.86 ± 4.78 days, = 0.014). The 6 min walk (6 MW) (317.92 ± 94.17 m vs. 387.08 ± 93.43 m, = 0.006), mini mental status (MMS) (25.72 ± 4.36 vs. 27.71 ± 1.9, = 0.048) and clinical frail scale (3.65 ± 1.32 vs. 2.82 ± 0.86, = 0.005) scores differed between patients who died within the first year after surgery compared to those who survived this period. In-hospital stay correlated with timed up-and-go (TUG) (TAU: 0.094, = 0.037), Barthel index (TAU-0.114, = 0.032), hand grip strength (TAU-0.173, < 0.001), and EuroSCORE II (TAU 0.119, = 0.008). ICU/IMC stay duration correlated with TUG (TAU 0.186, < 0.001), 6 MW (TAU-0.149, = 0.002), and hand grip strength (TAU-0.22, < 0.001). FRAIL patients had post-operatively altered levels of plasma-redox-biomarkers and fat-soluble micronutrients.
frailty parameters with the highest predictive value as well as ease of use could be added to the EuroSCORE.
衰弱在心胸外科手术中的重要性日益凸显，是不良结局和死亡率的危险因素。此后开发了各种衰弱评分，但对于心脏手术使用哪种评分尚无共识。
在一项针对接受心脏手术患者的全人群前瞻性研究中，我们评估了衰弱情况，并分析了住院并发症发生率、1年死亡率以及手术前后的实验室指标。
对纳入的246例患者进行了分析。共有16例患者（6.5%）衰弱，130例患者（52.85%）为衰弱前期，将其汇总为衰弱组（FRAIL）并与非衰弱患者（NON-FRAIL）进行比较。平均年龄为66.5±9.05岁，女性占21.14%。住院死亡率为4.88%，1年死亡率为6.1%。衰弱患者住院时间更长（FRAIL组15.53±8.5天 vs. NON-FRAIL组13.71±8.94天，P = 0.004），在重症/中级护理病房（ITS/IMC）的时间也更长（FRAIL组5.4±4.33天 vs. NON-FRAIL组4.86±4.78天，P = 0.014）。术后1年内死亡的患者与存活患者相比，6分钟步行试验（6MW）（317.92±94.17米 vs. 387.08±93.43米，P = 0.006）、简易精神状态检查表（MMS）（25.72±4.36 vs. 27.71±1.9，P = 0.048）和临床衰弱量表（3.65±1.32 vs. 2.82±0.86，P = 0.005）评分存在差异。住院时间与计时起立行走试验（TUG）（tau = 0.094，P = 0.037）、巴氏指数（tau = -0.114，P = 0.032）、握力（tau = -0.173，P < 0.001）和欧洲心脏手术风险评估系统II（EuroSCORE II）（tau = 0.119，P = 0.008）相关。ICU/IMC住院时间与TUG（tau = 0.186，P < 0.001）、6MW（tau = -0.149，P = 0.002）和握力（tau = -0.22，P < 0.001）相关。衰弱患者术后血浆氧化还原生物标志物和脂溶性微量营养素水平发生改变。
预测价值最高且易于使用的衰弱参数可添加到欧洲心脏手术风险评估系统中。
