Clinical Impact of Measures for Frailty Severity in Poor-Risk Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia

• Published in: Journal of Atherosclerosis and Thrombosis 2022/02/01, Vol.29(2), pp.221-228
• Main Authors: Takahara, Mitsuyoshi, Iida, Osamu, Soga, Yoshimitsu, Azuma, Nobuyoshi, Nanto, Shinsuke
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Chronic limb-threatening ischemia; Chronic Limb-Threatening Ischemia - complications; Chronic Limb-Threatening Ischemia - surgery; Cohort Studies; Correlation; Female; Frailty; Frailty - complications; Frailty - diagnosis; Humans; Japan; Limb Salvage; Male; Original; Patient Selection; Predictive Value of Tests; Revascularization; Severity of Illness Index; Treatment Outcome
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.61481

Aim: This study aimed to demonstrate the clinical impact of various frailty-related aspects in poor-risk patients undergoing revascularization for chronic limb-threatening ischemia (CLTI). Methods: We analyzed a clinical database of a prospective multicenter observational study. A total of 562 CLTI patients who required assistance for their daily lives and were candidates for revascularization were included. We examined various measures of frailty severity, including activities of daily living (ADL)/mobility, physical performance, nutritional status, cognitive function, and cardiac function at baseline (before revascularization). Data on inflammatory markers at baseline and ADL/mobility before CLTI onset were also collected. Results: The patients were aged 77±10 years, 65% were non-ambulatory, and 38% were categorized as mild dementia or severer. The correlation coefficients between the frailty measures ranged from 0.00 to 0.91. The random forest analysis for one-year mortality risk showed that these frailty-related measures, as well as age and inflammatory markers, had a relatively high variable importance compared with comorbidities and limb severity. Conclusion: The correlations between measures of frailty severity were not always strong but rather widely varied in CLTI patients who required assistance for their daily lives and were candidates for revascularization. Measures of frailty severity, as well as age and inflammatory markers, had a relatively large predictive impact on one-year mortality risk compared with comorbidities and limb severity in the population.