Associations of Clinical Frailty with Severity of Limb Threat and Outcomes in Chronic Limb-threatening Ischaemia
Associations of Clinical Frailty with Severity of Limb Threat and Outcomes in Chronic Limb-threatening Ischaemia
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DOI：
10.1016/j.avsg.2021.04.017
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发表时间：
2021-11-10
影响因子：
1.5
通讯作者：
Sayers, Rob
中科院分区：
文献类型：
--
作者：
Houghton, John S. M.;Nickinson, Andrew T. O.;Sayers, Rob
目的：调查的脆弱性和严重程度的慢性肢体威胁性缺血（CLTI）的关系，和他们的比较协会与一年的结果，在患者提出了一个血管保肢（VaLS）clinic.Methods：这项回顾性队列研究利用收集的数据从一个前瞻性维护VaLS临床数据库。纳入了2018年2月至2019年4月期间因CLTI到VaLS诊所就诊的年龄≥ 50岁的患者。使用临床虚弱量表（CFS）测量虚弱程度，并通过伤口、缺血和足部感染（WIfI）评分测量肢体威胁严重程度。过度的多种药物治疗被定义为>= 10种药物。计算所有患者的抗胆碱能负荷（ACB）评分和Charlson合并症指数（CCI）。主要结局指标是1年时死亡或截肢的复合终点。与结果的相关性采用考克斯回归进行评估，并报告为风险比（HR）与95%置信区间（CI）。结果：共纳入198例患者，CFS评分可用于190例患者。98例患者（52%）虚弱（CFS >= 5）。127例患者（67%）最初接受了血管内血运重建术。过度的多种药物治疗很常见（55例患者; 28%）。虚弱与WIfI分期增加（P = 0.025）以及年龄、女性、CCI评分、药物治疗次数、过度多药治疗相关，但与ACB评分无关。虚弱患者更常接受非手术治疗（P = 0.017）。虚弱（HR 1.91;在单变量分析中，WIfI 4期（HR 3.29; 95%CI 1.23，8.80; P = 0.018）与死亡或截肢相关。WIfI第4阶段（HR 2.80; 95%CI 1.04，7.57; P = 0.042）和CCI评分（HR 1.21; 95%CI 1.03，1.41; P = 0.015），但非虚弱（HR 1.25; 95%CI 0.67，2.33; P = 0.474），在多变量分析中与死亡或截肢独立相关。虚弱在CLTI患者中非常普遍，并且与肢体威胁的严重程度相关。CFS可能是CLTI患者风险评估的有用辅助工具。
Objective: Investigate the relationship of frailty and severity of chronic limb-threatening ischaemia (CLTI), and their comparative associations with one-year outcomes, in patients presenting to a vascular limb salvage (VaLS) clinic.Methods: This retrospective cohort study utilised data collected from a prospectively maintained VaLS clinic database. Patients aged >= 50 presenting to the VaLS clinic with CLTI between February 2018 and April 2019 were included. Frailty was measured using the Clinical Frailty Scale (CFS) and limb threat severity by the Wound, Ischaemia, and foot Infection (WIfI) score. Excessive polypharmacy was defined as >= 10 medications. Anticholinergic burden (ACB) score and Charlson comorbidity index (CCI) were calculated for all patients. The primary outcome measure was a composite endpoint of death or amputation at one-year. Associations with outcome were assessed using Cox regression and reported as hazards ratios (HR) with 95% confidence intervals (CI).Results: A total of 198 patients were included, with CFS scores available for 190 patients. 98 patients (52%) were frail (CFS >= 5). 127 patients (67%) initially underwent endovascular revascularisation. Excessive polypharmacy was common (55 patients; 28%). Frailty was associated with increased WIfI stage (P = 0.025) as well as age, female sex, CCI score, number of medications, excessive polypharmacy but not ACB score. Frail patients were more frequently managed non-operatively (P = 0.017). Frailty (HR 1.91; 95% CI 1.09, 3.34; P = 0.024) and WIfI stage 4 (HR 3.29; 95%CI 1.23, 8.80; P = 0.018) were associated with death or amputation on univariable analysis. WIfI stage 4 (HR 2.80; 95%CI 1.04, 7.57; P = 0.042) and CCI score (HR 1.21; 95%CI 1.03, 1.41; P = 0.015), but not frailty (HR 1.25; 95%CI 0.67, 2.33; P = 0.474), were independently associated with death or amputation on multivariable analysis.Conclusions: Frailty is highly prevalent among CLTI patients and related to severity of limb threat. The CFS may be a useful adjunct to patient risk assessment in CLTI.