Majmundar Monil, Wan-Chi Chan, Patel Kunal N, Majmundar Vidit, Vasudeva Rhythm, Hance Kirk A, Ali Adam, Hajj George, Thors Axel, Hu Jinxiang, Gupta Kamal
Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.
Vasc Med. 2025 Apr;30(2):138-146. doi: 10.1177/1358863X251316837. Epub 2025 Mar 13.
Peripheral artery disease (PAD) and end-stage kidney disease (ESKD) are independent risk factors affecting outcomes like in-hospital mortality. The role of a frailty index in prognosticating outcomes in patients with ESKD and PAD is unknown. We aim to assess the prognostic value of the Hospital Frailty Risk Score (HFRS) and its association with outcomes in these patients.
We identified patients with PAD using data from the United States Renal Data System (USRDS) for the years 2015-2018. These patients were stratified into three categories of frailty risk based on their HFRS, a validated frailty assessment tool using ICD-10 codes: low (< 5), intermediate (5-10), and high risk (> 10) and based on revascularization or not. Primary outcomes included in-hospital mortality and composite of mortality or major amputation. Secondary outcomes encompassed postdischarge mortality and composite of mortality or major amputation at 1 year.
Out of 122,649 patients with PAD and ESKD, 4118 underwent revascularization and 118,531 did not. In-hospital outcomes demonstrated a nonlinear relationship and postdischarge outcomes displayed a nearly linear relationship with HFRS, regardless of revascularization status. In both cohorts, the high-risk group was associated with a significantly higher risk of in-hospital mortality/amputation (revascularization: odds ratio [OR] 4.6, 95% CI 3.3-6.2, < 0.001; no revascularization: OR 3.1, 95% CI 2.8-3.3, < 0.001) and mortality (revascularization: OR 5.5, 95% CI 3.4-8.7, < 0.001; no revascularization: OR 5.1, 95% CI 4.6-5.6, < 0.001) compared with the low-risk group.
In patients with ESKD and PAD, the HFRS serves as a valuable predictor of mortality and amputation irrespective of revascularization. This information can support informed decision-making.
外周动脉疾病（PAD）和终末期肾病（ESKD）是影响诸如住院死亡率等预后的独立危险因素。虚弱指数在预测ESKD和PAD患者预后中的作用尚不清楚。我们旨在评估医院虚弱风险评分（HFRS）的预后价值及其与这些患者预后的关联。
我们使用美国肾脏数据系统（USRDS）2015 - 2018年的数据识别出PAD患者。这些患者根据其HFRS（一种使用ICD - 10编码的经过验证的虚弱评估工具）被分为三类虚弱风险：低风险（<5）、中度风险（5 - 10）和高风险（>10），并根据是否进行血运重建进行分层。主要结局包括住院死亡率以及死亡率或大截肢的复合结局。次要结局包括出院后死亡率以及1年时死亡率或大截肢的复合结局。
在122,649例PAD和ESKD患者中，4118例接受了血运重建，118,531例未接受。无论血运重建状态如何，住院结局与HFRS呈非线性关系，出院后结局与HFRS呈近似线性关系。在两个队列中，与低风险组相比，高风险组的住院死亡率/截肢风险（血运重建：比值比[OR] 4.6，95%置信区间3.3 - 6.2，P < 0.001；未进行血运重建：OR 3.1，95%置信区间2.8 - 3.3，P < 0.001）和死亡率（血运重建：OR 5.5，95%置信区间3.4 - 8.7，P < 0.001；未进行血运重建：OR 5.1，95%置信区间4.6 - 5.6，P < 0.001）显著更高。
在ESKD和PAD患者中，无论是否进行血运重建，HFRS都是死亡率和截肢的有价值预测指标。该信息可支持明智的决策制定。
