Esposito Augusto, Foffa Ilenia, Bastiani Luca, Vecoli Cecilia, Rizza Antonio, Storti Simona, De Caterina Alberto Ranieri, Mazzone Annamaria, Berti Sergio
Cardiology Unit, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", 54100 Massa, Italy.
Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100 Massa, Italy.
J Clin Med. 2023 Sep 12;12(18):5927. doi: 10.3390/jcm12185927.
This study aimed to develop a novel score based on common laboratory parameters able to identify frail and sarcopenic patients as well as predict mortality in elderly patients with severe aortic stenosis (AS) for tailored clinical decision-making. A total of 109 patients (83 ± 5 years; females, 68%) with AS underwent a multidisciplinary pre-operative assessment and finalized a "frailty-based management" for the AS interventional treatment. Laboratory parameters of statistically significant differences between sarcopenic and non-sarcopenic individuals were tested in the structural equation model (SEM) to build a Frailty Inflammation Malnutrition and Sarcopenia score (FIMS score). Mortality at 20 months of follow-up was considered an outcome. FIMS score, in particular, the cut-off value ≥ 1.28 was able to identify "frail" and "early frail" patients and predict mortality with a sensitivity of 83.3% and 82.6%, respectively ( = 0.001) and was an independent determinant associated with a higher risk of mortality (HR 5.382; -value = 0.002). The FIMS score, easily achievable and usable in clinical practice, was able to identify frail and sarcopenic patients as well as predict their adverse clinical outcomes. This score could provide appropriate guidance during decision-making regarding elderly patients with severe AS.
本研究旨在基于常见实验室参数开发一种新型评分系统,以识别衰弱和肌肉减少症患者,并预测重度主动脉瓣狭窄(AS)老年患者的死亡率,从而进行针对性的临床决策。共有109例AS患者(83±5岁;女性占68%)接受了多学科术前评估,并最终确定了针对AS介入治疗的“基于衰弱的管理方案”。在结构方程模型(SEM)中测试了肌肉减少症患者与非肌肉减少症患者之间具有统计学显著差异的实验室参数,以构建衰弱炎症营养不良和肌肉减少症评分(FIMS评分)。将20个月随访时的死亡率作为结局指标。FIMS评分,特别是临界值≥1.28能够识别“衰弱”和“早期衰弱”患者,并分别以83.3%和82.6%的敏感度预测死亡率(P=0.001),且是与较高死亡风险相关的独立决定因素(HR 5.382;P值=0.002)。FIMS评分在临床实践中易于获得和使用,能够识别衰弱和肌肉减少症患者,并预测其不良临床结局。该评分可为重度AS老年患者的决策提供适当指导。