Incidence and Predictors of In-Hospital Frailty Progression in Patients with Chronic Limb-Threatening Ischemia after Endovascular Therapy: Results of the RIGEL Study.
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引用次数: 0
Abstract
Aim: Frailty, particularly chronic limb-threatening ischemia (CLTI), is a major health concern in patients with peripheral artery disease. CLTI onset can lead to increased frailty and impaired ability to perform daily activities. However, its in-hospital frailty progression in these patients remain poorly defined. This study aims to address this knowledge gap.
Methods: We analyzed 841 CLTI patients (mean age, 75.8 years; 60.2% male) who underwent endovascular therapy (EVT) and were discharged alive from a multicenter registry. Frailty was assessed at admission and discharge using the Clinical Frailty Scale (CFS), categorized as non-frail (1-3), mildly frail (4-5), or advanced frail (6-9). Frailty progression was defined as a transition to a higher frailty category during hospitalization. The predictors of frailty progression during hospitalization were assessed using logistic regression analyses.
Results: Overall, 103 patients (12.2%) experienced frailty progression. Compared to those without progression, these patients had lower left ventricular ejection fraction (LVEF), lower hemoglobin and albumin levels, and more severe wounds. Independent predictors of frailty progression included LVEF <40% (odds ratio [OR], 2.02), hemoglobin <11 g/dL (OR 1.67), and Wound Grade 3 (OR 2.04). Within 2 years after discharge, the amputation-free survival rate was significantly lower in the progression group than in the non-progression group (42.6% vs. 56.0%; log-rank p = 0.008). The wound healing rate within 2 years after EVT was also significantly lower in the progression group than in the non-progression group (78.2% vs. 88.8%; log-rank p = 0.001).
Conclusions: In-hospital frailty progression was observed in one of the eight patients with CLTI undergoing EVT. Frailty progression was linked to more severe clinical status and worse life and limb outcomes than cases without progression.
目的:虚弱,特别是慢性肢体威胁缺血(CLTI),是外周动脉疾病患者的主要健康问题。CLTI发作可导致身体虚弱和日常活动能力受损。然而,这些患者的住院虚弱进展仍然不明确。本研究旨在解决这一知识差距。方法:我们分析了841例CLTI患者(平均年龄75.8岁,60.2%男性),这些患者接受了血管内治疗(EVT),并在多中心登记中存活出院。在入院和出院时使用临床虚弱量表(CFS)评估虚弱程度,分为非虚弱(1-3)、轻度虚弱(4-5)或晚期虚弱(6-9)。虚弱进展被定义为住院期间向更严重的虚弱类别过渡。使用logistic回归分析评估住院期间虚弱进展的预测因素。结果:总体而言,103例患者(12.2%)出现虚弱进展。与无进展的患者相比,这些患者左心室射血分数(LVEF)较低,血红蛋白和白蛋白水平较低,伤口更严重。衰弱进展的独立预测因子包括LVEF <40%(比值比[OR], 2.02)、血红蛋白<11 g/dL(比值比[OR], 1.67)和伤口3级(比值比2.04)。出院后2年内,进展组的无截肢生存率明显低于非进展组(42.6%比56.0%,log-rank p = 0.008)。EVT后2年内伤口愈合率进展组也显著低于非进展组(78.2% vs 88.8%; log-rank p = 0.001)。结论:在接受EVT治疗的8例CLTI患者中,有1例观察到住院虚弱进展。与没有进展的病例相比,虚弱进展与更严重的临床状态和更差的生命和肢体结局有关。