Comparison of Duke Activity Status Index with cardiopulmonary exercise testing in cancer patients

Li, Michael H.-G.; Bolshinsky, Vladimir; Ismail, Hilmy; Ho, Kwok-ming; Heriot, Alexander G.; Riedel, Bernhard

doi:10.1007/s00540-018-2516-6

Cited by 19 publications

(13 citation statements)

References 33 publications

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“…Our findings are similar to previous results obtained in small cohort studies (n¼50, abdominal surgery 12 ; n¼43, intracavity cancer surgery 13 ), in which the DASI was a reasonably sensitive and specific predictor of AT (!11 ml kg À1 min À1 : AUROC 0.767, 95% CI 0.630e0.994; P¼0.0002) and VO 2 peak (>15 ml kg À1 min À1 : AUROC 0.765, 95% CI 0.620e0.900; P¼0.002). 12 Owing to our larger sample size using the METS study dataset 14 our results have increased precision as reflected by the narrower CIs.…”

Section: Differences In Prior Literaturesupporting

confidence: 91%

“…In the perioperative setting, a limited number of small studies report that the DASI has moderate correlation with the VO 2 peak (R 2 ¼0.2e0.45) as measured by CPET in patients undergoing intra-abdominal surgery. 12,13 The Measurement of Exercise Tolerance before Surgery (METS) study, 14 a large international multicentre study, compared the prognostic accuracy of subjective preoperative assessment, various tools measuring fitness (DASI and CPET) and pro-B-type natriuretic peptide to assess the composite primary endpoint of myocardial infarction or death within 30 days after major noncardiac surgery. The DASI score was associated with improved ability to predict the primary outcome of the composite of myocardial infarction or death within 30 days after surgery, whereas the other assessed tools, including CPET, had limited ability to do so.…”

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confidence: 99%

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A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Lee

Cuthbertson

et al. 2021

British Journal of Anaesthesia

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Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods: In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg À1 min À1 and peak oxygen consumption (VO 2 peak) >16 ml kg À1 min À1 , cut-points that represent a reduced risk of postoperative complications. Results: Five questions were identified to have dominance in predicting AT>11 ml kg À1 min À1 and VO 2 peak>16 ml.kg À1 min À1 . These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg À1 .min À1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q¼0.67 vs original 12-question DASI¼0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg À1 .min À1 and VO 2 peak<16 ml.kg À1 .min À1 . Conclusions: The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

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Section: Differences In Prior Literaturesupporting

confidence: 91%

mentioning

confidence: 99%

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Lee

Cuthbertson

et al. 2021

British Journal of Anaesthesia

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“…The Duke Activity Status Index (DASI) has previously shown modest correlation with peak oxygen uptake in patients undergoing intra-abdominal surgery for cancer. 34,35 The METS trial Incidence of use of biomarkers for preoperative risk assessment. This figure shows that albumin is most frequently used to assess nutrition.…”

Section: Exercise Assessment and Prehabilitationmentioning

confidence: 99%

A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

Bolshinsky

Ismail

et al. 2019

Can J Anesth/J Can Anesth

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“…They reported that the Dukes Activity Status Index, a questionnaire to assess fitness levels and estimate VO 2 peak, correlated poorly with CPET in pre-operative cancer patients and concluded that, contrary to our findings using TUG, they could not recommend Dukes Activity Status Index as a triage tool for CPET. 25 TUG in this context would provide an objective and easily quantifiable method of triaging such patients.…”

Section: Discussionmentioning

confidence: 99%

Using a quick timed‐up‐and‐go test to predict surgical risk

Boereboom

McGuinness

Herrod

et al. 2021

JCSM Rapid Communications

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Background Cardiorespiratory fitness (CRF) has important implications for post-operative recovery. The timedup-and-go (TUG) test is a cheap and simple method to assess a patient's functional performance; although how well TUG correlates with results of a cardiopulmonary exercise test (CPET), the gold standard measure of CRF is unknown. Therefore, the aim of this study was to assess the correlation between CPET-derived parameters of CRF and TUG times in a group of older adults. Methods Ninety-eight independent community dwelling older adults [mean age: 72 years (range: 61-86), mean body mass index: 26.3 ± 3.1 kg/m 2 , 54 male] were recruited to this study; completing 180 CPET and TUG testing sessions over a 28 month period. The correlation between CPET-derived CRF parameters and TUG time was assessed, and receiver operating characteristic curve analysis was performed to determine clinically useful cut-off points in TUG time. Results Median TUG time was 7.1 s [interquartile range (IQR): 4-8.5], median VO 2 peak was 24.4 mL/kg/min (IQR: 20.2-29.2), and the median anaerobic threshold (AT) was 13.4 mL/kg/min (IQR: 8.6-16.5). There was a statistically significant negative correlation between TUG time and AT (r = À0.317, P = <0.0001) and TUG time and VO 2 peak (r = À0.4247, P < 0.0001). Receiver operating characteristic curve analysis determined a TUG time of ≥6.5 s to have an 82% sensitivity and 60% specificity to detect an AT <11.0 mL/kg/min, the point at below which perioperative mortality is known to increase. Conclusions Despite strong evidence for the utility of pre-operative CPET in stratifying surgical risk, CPET is not universally available. Our finding of a correlation between TUG time and CPET-derived parameters of CRF (AT/VO 2 peak) suggests that TUG may be a useful surrogate in the pre-operative setting.

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Comparison of Duke Activity Status Index with cardiopulmonary exercise testing in cancer patients

Cited by 19 publications

References 33 publications

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

Using a quick timed‐up‐and‐go test to predict surgical risk

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