Frailty index predicts severe complications in gynecologic oncology patients
Frailty index predicts severe complications in gynecologic oncology patients
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DOI：
10.1016/j.ygyno.2015.01.532
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发表时间：
2015-04-01
影响因子：
4.7
通讯作者：
Rose, Stephen L.
中科院分区：
文献类型：
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作者：
Uppal, Shitanshu;Igwe, Elena;Rose, Stephen L.
Objective.本研究的目的是量化虚弱指数对妇科癌症手术后30天Clavien IV级（需要重症监护支持）和V级（30天死亡率）并发症的预测价值。纳入2008-2011年国家外科质量改进计划（NSQIP）的患者最终诊断为妇科恶性肿瘤。用11个变量计算改良虚弱指数（MFI）。较高的mFI评分表明更严重的合并症。Logistic回归分析用于控制已知的并发症预测因素。在总计6551例患者中，188例（2.9%）患者发生了Clavien IV/V并发症。2958例患者评分为0（45.2%），2405例患者评分为I（36.7%），985例患者评分为2（15%），162例患者评分为3（2.5%），41例患者评分≥ 4（0.6%）。当mFI评分为0、1、2、3和>= 4时，Clavien IV/V并发症的发生率分别为2%、2.7%、4.4%、7.4%和24.4%（p < 0.001）。在逻辑回归模型中，发现对预测Clavien IV和V并发症有意义的变量为术前白蛋白= 4 = 12.5）。采用白蛋白和mFI这两个术前因素可以更精确地识别需要ICU护理的高危女性（>10%风险）。改良虚弱指数（mFI）可预测妇科癌症手术后重症监护支持的需求和30天死亡率。(C)2015 Elsevier Inc. All rights reserved.
Objective. The purpose of this study was to quantify the predictive value of frailty index on 30-day Clavien class IV (requiring critical care support) and class V (30-day mortality) complications after gynecologic cancer surgery.Methods. Patients included in the National Surgical Quality Improvement Program (NSQIP) 2008-2011 had a final diagnosis of gynecologic malignancy. Modified frailty index (mFI) was calculated with 11 variables. Higher mFI scores indicated more severe comorbidities. Logistic regression was used to control for known predictors of complications.Results. Of the total 6551 patients, 188 (2.9%) of the patients experienced a Clavien IV/V complication. 2958 patients had a score of 0 (45.2%), 2405 patients had a score of I (36.7%), 985 patients had a score of 2 (15%), 162 patients had a score of 3 (2.5%) and 41 patients had a score >= 4 (0.6%). The rates of Clavien IV/V complications were 2%, 2.7%, 4.4%, 7.4% and 24.4% for mFI scores of 0, 1, 2, 3 and >= 4, respectively (p < 0.001). Variables found to be significant for predicting Clavien IV and V complications on logistic regression modeling were preoperative albumin = 4 = 12.5). Taking the two preoperative factors of albumin and mFI allowed for greater precision in identifying women who are at higher risk for requiring ICU care (>10% risk).Conclusions. Modified frailty index (mFI) is predictive of the need for critical care support and 30-day mortality after surgery for gynecologic cancer. (C) 2015 Elsevier Inc. All rights reserved.