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Szabó A, Szabó D, Tóth K, Szécsi B, Szentgróti R, Nagy Á, Eke C, Sándor Á, Benke K, Merkely B, Gál J, Székely A. Comprehensive frailty assessment with multidimensional frailty domains as a predictor of mortality among vascular and cardiac surgical patients. Physiol Int 2023. [PMID: 37133997 DOI: 10.1556/2060.2023.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 05/04/2023]
Abstract
Purpose The frailty concept has become a fundamental part of daily clinical practice. In this study our purpose was to create a risk estimation method with a comprehensive aspect of patients' preoperative frailty. Patients and methods In our prospective, observational study, patients were enrolled between September 2014 and August 2017 in the Department of Cardiac Surgery and Department of Vascular Surgery at Semmelweis University, Budapest, Hungary. A comprehensive frailty score was built from four main domains: biological, functional-nutritional, cognitive-psychological and sociological. Each domain contained numerous indicators. In addition, the EUROSCORE for cardiac patients and the Vascular POSSUM for vascular patients were calculated and adjusted for mortality. Results Data from 228 participants were included for statistical analysis. A total of 161 patients underwent vascular surgery, and 67 underwent cardiac surgery. The preoperatively estimated mortality was not significantly different (median: 2.700, IQR (interquartile range): 2.000-4.900 vs. 3.000, IQR: 1.140-6.000, P = 0.266). The comprehensive frailty index was significantly different (0.400 (0.358-0.467) vs. 0.348 (0.303-0.460), P = 0.001). In deceased patients had elevated comprehensive frailty index (0.371 (0.316-0.445) vs. 0.423 (0.365-0.500), P < 0.001). In the multivariate Cox model an increased risk for mortality in quartiles 2, 3 and 4 compared with quartile 1 as a reference was found (AHR (95% CI): 1.974 (0.982-3.969), 2.306 (1.155-4.603), and 3.058 (1.556-6.010), respectively). Conclusion The comprehensive frailty index developed in this study could be an important predictor of long-term mortality after vascular or cardiac surgery. Accurate frailty estimation could make the traditional risk scoring systems more accurate and reliable.
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Affiliation(s)
- András Szabó
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Dominika Szabó
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Krisztina Tóth
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Balázs Szécsi
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Rita Szentgróti
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- 3Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Csaba Eke
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 4Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Kálmán Benke
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - János Gál
- 4Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Székely
- 1Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
- 2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Tóth K, Szabó A, Nagy Á, Szabó D, Szécsi B, Eke C, Sándor Á, Susánszky É, Holndonner-Kirst E, Merkely B, Gál J, Székely A. Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery. Ann Palliat Med 2021; 10:11333-11347. [PMID: 34670385 DOI: 10.21037/apm-21-1015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients. METHODS Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality. RESULTS The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). CONCLUSIONS The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.
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Affiliation(s)
- Krisztina Tóth
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - András Szabó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Dominika Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Szécsi
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Csaba Eke
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Éva Susánszky
- Institute of Behavioural Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Enikő Holndonner-Kirst
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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Szabó A, Tóth K, Nagy Á, Domokos D, Czobor N, Eke C, Sándor Á, Merkely B, Susánszky É, Gál J, Székely A. The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery. BMC Geriatr 2021; 21:46. [PMID: 33441102 PMCID: PMC7805183 DOI: 10.1186/s12877-020-01994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. Methods In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. Results The patients’ mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). Conclusion Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.
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Affiliation(s)
- András Szabó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary.
| | - Krisztina Tóth
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Nikoletta Czobor
- Department of Anesthesiology and Intensive Care, Medical Centre of Hungarian Defense Forces, Budapest, Hungary
| | - Csaba Eke
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Éva Susánszky
- Institute of Behavioural Science, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
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Lagos N, Gallé M, Chernov A, Sándor Á. Enriching how-to guides with actionable phrases and linked data. WEB 2017. [DOI: 10.3233/web-170364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Lagos
- Naver Labs Europe, 6 chemin de Maupertuis, Meylan, France. E-mails: , ,
| | - Matthias Gallé
- Naver Labs Europe, 6 chemin de Maupertuis, Meylan, France. E-mails: , ,
| | - Alexandr Chernov
- University of Tübingen, Wilhelmstr. 19, Tübingen, Germany. E-mail:
| | - Ágnes Sándor
- Naver Labs Europe, 6 chemin de Maupertuis, Meylan, France. E-mails: , ,
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