Age predicts outcomes better than frailty following aneurysmal subarachnoid hemorrhage: A retrospective cohort analysis

McIntyre, Matthew K.; Gandhi, Chirag D.; Long, Andrew; Hoof, Alexander Van; Li, Boyi; Patel, Vikas; Afridi, Adil; Halabi, Mohamed; Schmidt, Meic H.; Cole, Chad; Santarelli, Justin; Al‐Mufti, Fawaz; Bowers, Christian A.

doi:10.1016/j.clineuro.2019.105558

Cited by 29 publications

(38 citation statements)

References 21 publications

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“…Unexpectedly, MFI-11 and MFI-5 were not well able to predict the outcomes in aSAH. This was also reported in a previous study of aSAH [25]. There are a few potential reasons that this might be the case.…”

Section: Discussionsupporting

confidence: 85%

“…In neurosurgery, the concept of frailty has been explored in various subspecialty conditions including brain tumour [19,20], chronic subdural haematoma [21], and spine surgery [22][23][24]. Although some work has been published on aSAH in the frail [25,26] and in the elderly [27,28], there has been no study comparing the various indices on the outcomes of this condition. Sarcopaenia and osteopaenia, the loss of muscle and bone mass, has been noted to be associated with frailty [29,30].…”

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confidence: 99%

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Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

Lim

Kumar

et al. 2021

Preprint

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IntroductionAneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. In the context of acute brain injury, frailty, sarcopaenia and osteopaenia have become increasing concerns. Multiple indices have been devised in various surgical specialties to predict outcome and guide management. In this study, we examined whether such markers have relevance towards outcomes from acute brain conditions, such as aSAH. MethodsAn observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]), temporalis (TMT) and zygoma thickness (markers of sarcopaenia and osteopaenia), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. ResultsTMT was the best performing marker in our cohort with an AUC of 0.82, Somers’ D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69, Somer’s D 0.40, Tau 0.16), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68, Somer’s D 0.43, Tau 0.17). After multivariate analysis, patients with TMT ≥5.5mm (defined as non-frail), were less likely to experience complications (OR 0.20 [0.06 – 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. ConclusionTMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes Trial registrationNot applicable

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

Lim

Kumar

et al. 2021

Preprint

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“…Frailty is an emerging concept that aims to quantify the cumulative effect of these comorbidities in order to more accurately prognosticate outcomes. In neurosurgery specifically, frailty has been associated with poorer outcomes following subarachnoid hemorrhage [ 5 , 11 ], spine surgery [ 16 ], intracranial hemorrhage [ 17 ], and intra-cranial tumor surgery [ 18 ]. Despite this, there are over 215 established frailty indices [ 7 ] and no consensus on the optimal scoring system or appropriate cutoffs [ 19 ]; something that may be disease and patient-population specific.…”

Section: Discussionmentioning

confidence: 99%

“…The eleven-factor modified frailty index (mFI-11) was calculated by assigning one point for the presence of each of the following pre-hemorrhage characteristics for a maximum of 11 points: hypertension requiring medication, congestive heart failure, myocardial infarction, previous percutaneous coronary intervention or angina, transient ischemic attack or cerebrovascular accident without neurological deficit, cerebrovascular accident with neurological deficit, peripheral vascular disease or ischemic chest pain, chronic obstructive pulmonary disease or current pneumonia, diabetes mellitus, non-independent functional status, and impaired sensorium (Table 1 ). Non-independent functional status was defined as requiring assistance from another person for activities of daily living [ 8 - 11 ]. The five-factor modified frailty index (mFI-5) was defined similarly but with the presence of hypertension requiring medication, congestive heart failure, chronic obstructive pulmonary disease or current pneumonia, diabetes mellitus, or non-independent functional status [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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Background Initial Glasgow Coma Score (iGCS) is a well-known predictor of adverse outcomes following chronic subdural hemorrhage (cSDH). Frailty, i.e. a reduced physiologic reserve, is associated with poorer outcomes across the surgical literature, however, there is no consensus on the best measure of frailty. To date, no study has compared frailty’s ability to predict cSDH outcomes versus iGCS. The goal of this study was to, therefore, examine the prognostic value of the 5- (mFI-5) and 11-factor (mFI-11) modified frailty index, and Charlson Comorbidity Index (CCI) versus iGCS following cSDH. Methods Between January, 2016 and June, 2018, patients who presented to the emergency department with cSDH were retrospectively identified using the International Classification of Diseases (ICD) codes. mFI-5, mFI-11, and CCI scores were calculated using patient baseline characteristics. Primary endpoints were death and discharge home and subgroup analyses were performed among operative cSDH. Univariate and multivariate logistic regressions were used to determine predictors of primary endpoints. Results Of the 109 patients identified, the average age was 72.6±1.6 years and the majority (69/109, 63.3%) were male. The average CCI, mFI-5, and mFI-11 were 4.5 ±0.2, 1.5 ±0.1, and 2.2 ±0.1, respectively. Fifty (45.9%) patients required surgical intervention, 11 (10.1%) died, and 48 (43.4%) were discharged home. In the overall cohort, while the only multivariate predictor of mortality was iGCS (OR=0.58; 95%CI:0.44-0.77; p=0.0001), the CCI (OR=0.73; 95%CI:0.58-0.92; p=0.0082) was a superior predictor of discharge home compared to iGCS (OR=1.46; 95%CI:1.13-1.90; p=0.0041). Conversely, among those who received an operative intervention, the CCI, but not iGCS, independently predicted both mortality (OR=4.24; 95%CI:1.01-17.86; p=0.0491) and discharge home (OR=0.55; 95%CI:0.33-0.90; p=0.0170). Neither mFI nor age predicted primary outcomes in multivariate analysis. Conclusion While frailty is associated with worse surgical outcomes, the clinical utility of the mFI-5, mFI-11, and CCI in cSDH is unclear. We show that the iGCS is an overall superior predictor of mortality following cSDH but is outperformed by the CCI after operative intervention. Similarly, the CCI is the superior predictor of discharge home in cSDH patients overall and following an operative intervention. These results indicate that while the iGCS best predicts mortality overall, the CCI may be considered when prognosticating post-operative course and hospital disposition.

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“…Though there have been many studies examining cranial neurosurgical patient outcomes using both the CCI and the mFI-11 (Table 5), to our knowledge, the present study is the first to investigate the mFI-5's utility in predicting postoperative outcomes within this specific patient population. 1,5,11,12,[20][21][22][23][24][25][26][27]…”

Section: -Factor Modified Frailty Indexmentioning

confidence: 99%

The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients

Khalafallah

Huq

Jimenez

et al. 2020

Journal of Neurosurgery

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OBJECTIVEHealth measures such as the Charlson Comorbidity Index (CCI) and the 11-factor modified frailty index (mFI-11) have been employed to predict general medical and surgical mortality, but their clinical utility is limited by the requirement for a large number of data points, some of which overlap or require data that may be unavailable in large datasets. A more streamlined 5-factor modified frailty index (mFI-5) was recently developed to overcome these barriers, but it has not been widely tested in neuro-oncology patient populations. The authors compared the utility of the mFI-5 to that of the CCI and the mFI-11 in predicting postoperative mortality in brain tumor patients.METHODSThe authors retrospectively reviewed a cohort of adult patients from a single institution who underwent brain tumor surgery during the period from January 2017 to December 2018. Logistic regression models were used to quantify the associations between health measure scores and postoperative mortality after adjusting for patient age, race, ethnicity, sex, marital status, and diagnosis. Results were considered statistically significant at p values ≤ 0.05. Receiver operating characteristic (ROC) curves were used to examine the relationships between CCI, mFI-11, and mFI-5 and mortality, and DeLong’s test was used to test for significant differences between c-statistics. Spearman’s rho was used to quantify correlations between indices.RESULTSThe study cohort included 1692 patients (mean age 55.5 years; mean CCI, mFI-11, and mFI-5 scores 2.49, 1.05, and 0.80, respectively). Each 1-point increase in mFI-11 (OR 4.19, p = 0.0043) and mFI-5 (OR 2.56, p = 0.018) scores independently predicted greater odds of 90-day postoperative mortality. Adjusted CCI, mFI-11, and mFI-5 ROC curves demonstrated c-statistics of 0.86 (CI 0.82–0.90), 0.87 (CI 0.83–0.91), and 0.87 (CI 0.83–0.91), respectively, and there was no significant difference between the c-statistics of the adjusted CCI and the adjusted mFI-5 models (p = 0.089) or between the adjusted mFI-11 and the adjusted mFI-5 models (p = 0.82). The 3 indices were well correlated (p < 0.01).CONCLUSIONSThe adjusted mFI-5 model predicts 90-day postoperative mortality among brain tumor patients as well as our adjusted CCI and adjusted mFI-11 models. The simplified mFI-5 may be easily integrated into clinical workflows to predict brain tumor surgery outcomes in real time.

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Age predicts outcomes better than frailty following aneurysmal subarachnoid hemorrhage: A retrospective cohort analysis

Cited by 29 publications

References 21 publications

Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients

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