Wang Yi-Xuan, Zhao Wen-Xin, Wang Zi-Mo, Zhao Ning, Li Zhao-Long, Wu Zhi-Yuan, Diao Yong-Peng, Li Yong-Jun
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking University Fifth School of Clinical Medicine.
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
J Nutr Health Aging. 2025 Apr;29(4):100489. doi: 10.1016/j.jnha.2025.100489. Epub 2025 Jan 18.
This study aimed to evaluate the impact of frailty and inflammation on all-cause mortality in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR), and key risk factors were also explored.
A retrospective analysis was conducted on 174 patients with AAA who underwent EVAR at Beijing Hospital between 2016 and 2024. Frailty was assessed using the modified five-item Frailty Index (mFI-5). Inflammation was quantified by the red cell distribution width-to-albumin ratio (RAR), a novel inflammatory marker. We examined the associations between frailty, preoperative risk factors, and mortality using Kaplan-Meier survival analysis and Cox proportional hazards models. Mediation analysis was performed to evaluate the role of RAR in the relationship between frailty and mortality.
Frailty was found to be an independent risk factor for all-cause mortality following EVAR (HR = 1.95, P = 0.048). Preoperative anemia (HR = 0.98, P = 0.032), elevated creatinine levels (HR = 1.01, P = 0.013), and prolonged operation time (HR = 1.01, P = 0.029) were also independent predictors of mortality. Kaplan-Meier survival analysis revealed significantly lower survival rates for frailty patients (P = 0.004). Additionally, RAR mediated 23.8% of the relationship between frailty and mortality (P = 0.012), underscoring its role as a key indicator of chronic inflammation.
Frailty and chronic inflammation, as measured by the innovative RAR marker, are significant contributors to mortality after EVAR. This study highlights the clinical utility of RAR in identifying high-risk AAA patients and its potential for guiding targeted preoperative interventions. Incorporating frailty assessments and inflammation monitoring into routine preoperative evaluations may improve patient outcomes by enabling personalized approaches such as nutritional optimization and inflammation control.
本研究旨在评估衰弱和炎症对接受血管内动脉瘤修复术（EVAR）的腹主动脉瘤（AAA）患者全因死亡率的影响，并探讨关键风险因素。
对2016年至2024年在北京医院接受EVAR的174例AAA患者进行回顾性分析。使用改良的五项衰弱指数（mFI-5）评估衰弱情况。通过红细胞分布宽度与白蛋白比值（RAR）对炎症进行量化，RAR是一种新型炎症标志物。我们使用Kaplan-Meier生存分析和Cox比例风险模型研究衰弱、术前风险因素与死亡率之间的关联。进行中介分析以评估RAR在衰弱与死亡率关系中的作用。
发现衰弱是EVAR术后全因死亡率的独立危险因素（HR = 1.95，P = 0.048）。术前贫血（HR = 0.98，P = 0.032）、肌酐水平升高（HR = 1.01，P = 0.013）和手术时间延长（HR = 1.01，P = 0.029）也是死亡率的独立预测因素。Kaplan-Meier生存分析显示衰弱患者的生存率显著较低（P = 0.004）。此外，RAR介导了衰弱与死亡率之间23.8%的关系（P = 0.012），突出了其作为慢性炎症关键指标的作用。
通过创新的RAR标志物测量的衰弱和慢性炎症是EVAR术后死亡率的重要影响因素。本研究强调了RAR在识别高危AAA患者方面的临床实用性及其指导针对性术前干预的潜力。将衰弱评估和炎症监测纳入常规术前评估中，通过采用营养优化和炎症控制等个性化方法，可能改善患者预后。
