Glasgow Aneursym Score: A Predictor of Long-Term Mortality Following Endovascular Repair of Abdominal Aortic Aneurysm?

Abstract

Background To evaluate the value of Glasgow Aneurysm Score (GAS) in predicting long-term mortality and survival in patients who have undergone endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Methods A retrospective single-center study of 257 patients with non-ruptured AAA undergoing EVAR between January 2013 and 2021. GAS scores were compared between the survivors and the long term mortality groups. Receiver operating characteristic curve (ROC) analysis was used to determine the optimum cut-off values of GAS values to determine the effect on late-mortality. Results 257 patients with a mean age of 69.75 ± 7.75 (46–92) underwent EVAR due to AAA. Forty-nine mortalities were observed, 4 (1.5%) were in-hospital mortalities. Fourty-five (17.8%) of the mortalities occured during the long-term follow-up. The average follow up period was 18.98 ± 22.84 months (0–88). GAS values were higher in the long-term mortality group compared to the survivors group (81.02 ± 10.33 vs 73.73 ± 10.46; p < 0.001). The area under the ROC curve for GAS was 0.682 and for a 56% sensitivity rate, the cut-off value for GAS was 77.5 with a specificity of 64% (p < 0.001). The number of patients with GAS values < 77.5 was 155, whilst 98 had GAS values > 77.5. The mortality rates in patients with GAS < 77.5 and GAS > 77.5 were: 12.8% (n = 20) and 24.8% (n = 25), respectively (p = 0.014). Every 1 point increase in GAS score resulted in a 1.06 fold increase in risk of late mortality (OR: 1.06, 95% CI, 1.03–1.09; p < 0.001). Moreover, every 10 point increase in GAS score resulted in almost a 2 fold increase in risk of long-term mortality (OR: 1.8, 95% CI, 1.3–2.5; p < 0.001). The mean survival rate of the patients during the follow up period was 90.6% for the 1st year, 82.6% for the 3rd year and 70.0% for the 5th year. Five year survival rates in patients with GAS < 77.5 and > 77.5 were 75.7% and 61.7%, respectively (p = 0.013). Conclusion Every 10 point increase in GAS score resulted in almost a 2 fold increase in risk of long-term mortality. Moreover, the mortality rates in patients above the GAS cut off value almost doubled compared to those below. Five year survival rates were 14% higher in those with GAS below the cut off value when compared to those above.