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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, Gurpegui Puente M, González Almárcegui I, Gutiérrez Ibañes P, Carrillo López A, Castiella García CM, Miguelena Hycka J. Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva 2022; 46:239-247. [PMID: 35248506 DOI: 10.1016/j.medine.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING Surgical ICU of a third level hospital. PATIENTS Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST ICU, in-hospital and 6-month mortality. RESULTS The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.
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Affiliation(s)
| | | | - L M Claraco Vega
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Gurpegui Puente
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - I González Almárcegui
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Gutiérrez Ibañes
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Carrillo López
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - J Miguelena Hycka
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, Gurpegui Puente M, González Almárcegui I, Gutiérrez Ibañes P, Carrillo López A, Castiella García CM, Miguelena Hycka J. Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva 2021; 46:S0210-5691(20)30341-7. [PMID: 33446376 DOI: 10.1016/j.medin.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING Surgical ICU of a third level hospital. PATIENTS Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST ICU, in-hospital and 6-month mortality. RESULTS The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.
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Affiliation(s)
| | | | - L M Claraco Vega
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - M Gurpegui Puente
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - I González Almárcegui
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - P Gutiérrez Ibañes
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | - A Carrillo López
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet , Zaragoza, España
| | | | - J Miguelena Hycka
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, España
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Eminovic S, Vincze G, Eglseer D, Riedl R, Sadoghi P, Leithner A, Bernhardt GA. Malnutrition as predictor of poor outcome after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 45:51-56. [PMID: 33244636 PMCID: PMC7801298 DOI: 10.1007/s00264-020-04892-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022]
Abstract
Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.
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Affiliation(s)
- Sandra Eminovic
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gabor Vincze
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Miguelena Hycka J, Claraco Vega LM, Gurpegui Puente M. Influence of frailty in the outcome of surgical patients over 70 years old with admission criteria in ICU. Cir Esp 2020; 99:41-48. [PMID: 32507310 DOI: 10.1016/j.ciresp.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Frailty degree can influence more than age or severity in the outcome of patients older than 70 years undergoing surgery of the digestive system that require immediate postoperative control in the ICU. METHODS A prospective and observational study of patients over 70 years of age who were admitted to the surgical ICU of a third level hospital immediately after an elective or emergent surgical intervention on the digestive system from June 1, 2018 until June 1, 2019. The variables age, frailty Clinical Frailty Scale (CFS), and modified Frailty Index (mFI), severity (APACHE II), type of surgery, surgical pathology were recorded upon admission. A bivariate analysis was performed to assess the influence of frailty and severity on hospital morbidity and mortality and baseline situation of the patient (in terms of dependence) at 6 months. RESULTS A total of 90 patients were recruited, 54.4% of whom were reoperated; 74.4% were initially discharged from the ICU, with 28.4% of readmission and directly associated to frailty (CFS and mFI: P<0.01). The overall mortality at 6 months was 44.5% being CFS (OR = 64.3; P<0.05, 95% CI: 12.3-333.9) and APACHE II (OR = 1.17; P<0.05; 95% CI: 1.04-1.32) the covariates that best related. CONCLUSIONS The estimation of frailty by CSF and mFI is directly associated to the surgical morbidity and readmission of elderly and severe patients admitted to the ICU. In addition, CFS and mFI has been efficient as a predictive of mortality at 6 months.
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Silva DDJN, Casimiro LGG, Oliveira MISD, Ferreira LBDC, Abelha FJPA. [The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes]. Rev Bras Anestesiol 2020; 70:3-8. [PMID: 32164996 DOI: 10.1016/j.bjan.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. METHODS Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65-85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. RESULTS The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). CONCLUSION We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
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Affiliation(s)
| | | | | | | | - Fernando José Pereira Alves Abelha
- Centro Hospitalar Universitário São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia e Fisiologia, Porto, Portugal.
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Silva DDJN, Casimiro LGG, Oliveira MISD, Ferreira LBDC, Abelha FJPA. The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32164996 PMCID: PMC9373388 DOI: 10.1016/j.bjane.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. Methods Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients’ ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65‒85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. Results The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). Conclusion We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
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Affiliation(s)
| | | | | | | | - Fernando José Pereira Alves Abelha
- Centro Hospitalar Universitário São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia e Fisiologia, Porto, Portugal.
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