Outcome Analysis Using the Modified Frailty Index-5 in Patients With Complex Aortoiliac Disease

Autores da FMUP

• João Paulo Fernandes Teixeira

  Autor

• João Manuel Palmeira Rocha Neves

  Autor

Participantes de fora da FMUP

• Nobrega, L
• Neves, A.
• Duarte Gamas, L
• Dias, P.
• Azevedo Cerqueira, A
• Ribeiro, H
• Vidoedo, J

Unidades de investigação

• Biomedicina

• Ciências da Saúde Pública e Forenses, e Educação Médica

Abstract

OBJECTIVES: 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 patients frailty. One of them is the modified frailty index-5 (mFl-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 mFl-5 as a potential postoperative prognostic indicator in this population. METHODS: 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 mFl-5 was applied to this population to evaluate the prognostic impact of this frailty marker on mortality and morbidity. RESULTS: In the long-term follow-up, mFl-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, mFl-5 was the prognostic factor better able of predicting MACE. No prognostic value was found regarding short-term outcomes. CONCLUSION: The mFl-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.

Keywords

• PERIPHERAL ARTERIAL-DISEASE; PREDICT ADVERSE OUTCOMES; INTER-SOCIETY CONSENSUS; CHRONIC KIDNEY-DISEASE; LOWER-EXTREMITY BYPASS; VASCULAR-SURGERY; AORTOBIFEMORAL BYPASS; PREOPERATIVE FRAILTY; MORTALITY; RISK