54 Modified Frailty Index is an Independent Predictor of Death in the Burn Population: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study
Abstract Introduction Previous studies in the burn population have noted frailty as an independent predictor of inpatient and outpatient mortality. The Modified Frailty Index (MFI) uses comorbidities tracked by the American College of Surgeons National Surgical Quality Improvement Program to help to predict morbidity and mortality in patients. The purpose of this study was to determine whether or not the MFI-5 and MFI-11 would predict mortality in the burn population. Methods A secondary analysis of the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables were conducted. Frailty was determined using the MFI-5 (functionally dependent, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, hypertension) and MFI-11 (using the aforementioned 5, as well as myocardial infarction, hypertension, delirium, transient ischemic attack/cerebrovascular accident (without deficits), cerebrovascular accident (with deficits), peripheral vascular disease) from comorbidities included in the Burn Registry. Patients were considered frail if they had an MFI > 1 on either scale. Multivariate regression was used to compare mortality between those who were and those were not considered frail based on this index. Results A total of 347 patients with a mean age of 43±17 years, 73 women and 274 men, were analyzed. Mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. As continuous variables, MFI-5 (OR 1.86; 95% CI 1.11–3.11; p-value 0.02) and MFI-11 (OR 1.83; 95% CI 1.18–2.8; p-value 0.007) were independent predictors of mortality. In addition, TBSA total, age, and female gender were all independent predictors of mortality. Having a MFI-11 > 1 was considered an independent predictor of mortality (OR 2.91; 95% CI 1.1–7.7; p-value 0.03); whereas, having a MFI-5 > 1 was not considered an independent predictor of mortality (OR 2.6; 95% CI 0.95–7; p-value 0.06). Conclusions A MFI-11 > 1 in the burn population was an independent predictor of mortality, as were total TBSA, age, and female gender. Given these findings, further study on the predictive value of MFI-11 in major burn injury is warranted.