scholarly journals Cognitive Impairment, Hypoalbuminemia, High CRP Level and Past History of Gastro-Intestinal Ulcer: 4 Markers of Frailty Which Identify Older Patients with Malignant Hemopathies Who Shouldn't Benefit from Chemotherapy

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4756-4756
Author(s):  
Stephanie Dubruille ◽  
Cindy Kenis ◽  
Vincent Thibaud ◽  
Yves Libert ◽  
Michel Delforge ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older Patients ◽  
Functional Decline ◽  
Albumin Level ◽  
Poor Survival ◽  
Frail Patients ◽  
One Year ◽  
To Receive ◽  
Frailty Score

Abstract INTRODUCTION: Major progresses have been achieved to identify older patients with malignant hemopathies who should be treated with standard doses of chemotherapy. However, a reliable frailty score remains urgently needed to better define the unsuspected vulnerable population that does not benefit from chemotherapy. In the literature, three clinical (functional decline, cognitive impairment (CI) and comorbidities) and two biological (low albumin level and high IL-6 level) factors are frequently associated with a poor overall survival (OS) and/or chemotherapy-related toxicities. OBJECTIVE: To investigate the reliability of a simple clinico-biological tool for the screening of frail patients with malignant hemopathies to predict a poor survival (<6 months). METHODS: 285 consecutive patients (65-90yrs) with malignant hemopathies admitted to receive chemotherapy where included in a prospective multicentric study conducted in the Inst. J. Bordet (ULB, Brussels) and in the University Hospitals Leuven (KU, Leuven). A Comprehensive Geriatric Assessment (CGA) was performed. Univariate and multivariate Cox proportional hazards models were used to evaluate the value of functional decline, abnormal cognitive function, comorbidities, low albumin and CRP level to predict 1-year survival. RESULTS: One hundred and ninety-two patients were evaluable for the clinico-biological screening tool (NHL, n=111; CLL, n=19; MM, n=29; AML, n=20; ALL, n=3; LMMC, n=7; MDS, n=3). Eighty-three percent were considered to have a more favorable prognosis (NHL, CLL or MM). Functional decline was associated with abnormal cognitive function (P=0.029) and inflammation (P=0.002). Based on our previous analyses in the Charlson Comorbidity Index we took the strongest prognostic factor: gastro-intestinal (GI) ulcer (P=0.001). A "frailty" scoring system was thus developed, based on our 4 independent predictive factors for poor survival: CI (MMSE<27, n=57), presence of GI ulcer (n=29), low albumin level (alb<3.5g/dl, n=57) and surrogate marker of IL-6 level (CRP≥2mg/l, n=146). The population was stratified into 3 groups: "fit" (score=0-1, n=102), "vulnerable" (score=2, n=58) and "frail" (score=3-4, n=32). The one-year survival was 80% in "fit" and 53% in "vulnerable" patients (HR=2.75; 95% CI=1.54-4.91; P=.001). In "frail" patients 38% were alive at one-year (HR=4.87; 95% CI=2.61-9.09; P<.001) with a median survival of 5 months. Causes of death remain disease-related in a majority of the patients (69%). CONCLUSIONS: In our selected population of "clinically fit patients" referred to receive chemotherapy for malignant hemopathies, our frailty score helps the clinician to predict a very poor outcome. This frailty score detects unsuspected frailty in patients who may benefit from palliative care. Ongoing prospective analyses in a larger cohort of malignant hemopathies will be updated to validate the reliability of this score. Disclosures Delforge: Amgen, Celgene, Janssen and Takeda: Consultancy; Celgene and Janssen: Research Funding.

Prediction of Poor Outcome in Older Patients Receiving Chemotherapy for Malignant Lymphoma: A New Frailty Scoring

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2353-2353
Author(s):  
Stephanie Dubruille ◽  
Cindy Kenis ◽  
Yves Libert ◽  
Michel Delforge ◽  
Catherine Choffray ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Board Of Directors ◽  
Older Patients ◽  
Causes Of Death ◽  
Functional Decline ◽  
Advisory Committees ◽  
Frail Patients ◽  
Vulnerable Patients ◽  
To Receive ◽  
Frailty Score

Abstract Introduction: Patients "clinically fit" to receive chemotherapy suffering from malignant hemopathies, are an heterogeneous population covering fit and vulnerable patients. Patients with geriatric syndromes and/or irreversible comorbidities are usually excluded from high dose chemotherapy. However, a reliable "frailty score" remains urgently needed to better define the vulnerable population that does not benefit from chemotherapy. In the literature, two clinical (functional decline and Mild Cognitive Impairment (MCI)) and two biological (anemia and inflammation) factors are frequently correlated with poor overall survival (OS) or chemotherapy-related toxicity. Objective: To determine a clinico-biological tool for the screening of vulnerable patients with malignant hemopathies presenting unacceptable chemotherapy-related toxicity or disappointing result defined as a poor OS. Methods: This prospective multicentric study was conducted in the institute 'Jules Bordet' (Brussels) and in the University Hospitals of Leuven (Leuven). A Comprehensive Geriatric Assessment (CGA) was performed to 251 consecutive patients (65-90yrs) with malignant hemopathies admitted to receive chemotherapy. Clinical data, biological parameters and causes of death were extracted from medical records. A screening tool composed of 0 to 4 of the prognostic factors (loss of functional autonomy (Activities of Daily Living scale [ADL]), MCI (Mini Mental State Examination [MMSE]), anemia [hemoglobin] and inflammation [CRP]) was applied to our population. Univariate and multivariate Cox proportional hazards model were used to predict OS. Results: One hundred and eighty two patients were evaluable for all characteristics (NHL, n=105; CLL, n=20; MM, n=26; AML, n=17; ALL, n=6; LMMC, n=3, MDS, n=5). Eighty-three percent had a more favorable prognosis (NHL, CLL or MM) and fifty-five percent have a first diagnosis of cancer. A "frailty" scoring system (range 0-4) was developed, based on items we identified as predictive factors: functional decline (ADL<6, n=94), Mild Cognitive Impairment (MCI) (MMSE<27, n=51), anemia (HB<11g/dl, n=90) and inflammation (CRP≥2mg/l, n=149). The population was stratified into 3 groups: fit (score=0-1, n=56), vulnerable (score= 2, n=60) and "frail" (score= 3 or 4, n=66). The OS was 86% in fit, 60% in vulnerable (hazard ratio (HR)=3.29; 95% CI=1.48-7.33; P=.004) and 41% in "frail" patients (HR=5.87; 95% CI=2.74-12.59; P<.001). Causes of death remain disease-related in a majority of the patients (82%). In our largest group of older patients (NHL, n=105), the frailty scoring was also applied (ADL<6, n=48; MMSE<27, n=29; HB<11g/dl, n=36; CRP≥2mg/l, n=85): the OS was 87% in fit (n=45), 65% in vulnerable (n=31) (HR=2.94; 95% CI=1.11-7.96; P=.034) and 41% in "frail" patients (n=29) (HR=6.61; 95% CI=2.60-16.83; P<.001) and thus reliable in this specific population. Conclusions: In our selected population of patients with malignant hemopathies and particularly in the group of NHL, "clinically fit" to receive chemotherapy, our "frailty score" helps clinician to predict a poor OS. This scoring detects unsuspected "frail" patients who may benefit from palliative care. Further prospective analyses in a larger population, are on going to refine the score in other malignant hemopathies in order to avoid overtreatment in these vulnerable older patients. Disclosures Maerevoet: roche: Membership on an entity's Board of Directors or advisory committees; ARGN-X: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees.

scholarly journals 160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
O Okuwoga ◽  
S Mufti
Keyword(s):  
Older Patients ◽  
Single Centre ◽  
Clinical Frailty Scale ◽  
Health Records ◽  
Frail Patients ◽  
Nice Guidance ◽  
Data Points ◽  
Continued Use ◽  
Support Decision Making ◽  
Frailty Score

Abstract Introduction It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital. Methods A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9). Results A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p &lt; 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients. Conclusion The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.

scholarly journals Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252237
Author(s):  
Karumathil M. Murali ◽  
Judy Mullan ◽  
Steven Roodenrys ◽  
Hicham I. Cheikh Hassan ◽  
Maureen Lonergan
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Analysis Of Covariance ◽  
End Stage Kidney Disease ◽  
Change Scores ◽  
Dialysis Vintage ◽  
One Year ◽  
End Stage

Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

scholarly journals Preoperative Cognitive Impairment and Postoperative Delirium Predict Decline in Activities of Daily Living after Cardiac Surgery—A Prospective, Observational Cohort Study

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 69
Author(s):  
Ulf Guenther ◽  
Falk Hoffmann ◽  
Oliver Dewald ◽  
Ramy Malek ◽  
Kathrin Brimmers ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Daily Living ◽  
Postoperative Delirium ◽  
Functional Decline ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Subsequent Treatment ◽  
Assessment Tools

Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; p < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; p < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); p = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); p = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.

scholarly journals Association Between Z Drugs Use and Risk of Cognitive Impairment in Middle-Aged and Older Patients With Chronic Insomnia

2021 ◽  
Vol 15 ◽  
Author(s):  
Fang Guo ◽  
Li Yi ◽  
Wei Zhang ◽  
Zhi-Jie Bian ◽  
Yong-Bo Zhang
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Drug Use ◽  
Older Patients ◽  
Independent Risk Factor ◽  
Drug Exposure ◽  
Chronic Insomnia ◽  
Middle Aged ◽  
Global Cognitive Function

Background: Benzodiazepines (BZDs) and Non-BZDs (NBZDs) have been widely used for patients with chronic insomnia. Long-term uses of BZDs may cause cognitive impairment and increase the risk for dementia in older patients. NBZD as an agonist of the GABAA receptor complex includes eszopiclone, zopiclone, zolpidem, and zaleplon, also collectively known as Z drugs. However, evaluations for an association between cognitive impairment and Z drug use have been limitedly performed. This study aimed to investigate the association between the risk of cognitive decline and exposure to Z drugs in middle-aged and older patients with chronic insomnia.Methods: Investigations were performed on patients with chronic insomnia who visited the outpatient Department of Neurology, Beijing Friendship Hospital, and were assessed for the global cognitive function (MoCA) and memory (AVLT), executive function (TMT-B), visuospatial ability (CDT), verbal function (BNT-30), and attention (DST). Multiple regression analysis was conducted to determine the independent factors of cognition and evaluated the effect of Z drug use (zolpidem and zopiclone) on cognition.Results: A total of 120 subjects were identified. In our analysis, BZD exposure density (P = 0.025, OR = 1.43, 95% CI, 1.25–1.86) was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia. Neither Z drug use (P = 0.103) nor Z drug exposure density (P = 0.765) correlated with global cognitive function. Moreover, there was a positive association between Z drug use and attention [(P = 0.002, OR = 0.42, 95% CI, 0.24–0.73)]. Additionally, income level (P = 0.001, OR = 0.23, 95% CI, 0.10–0.53), severity of insomnia (P = 0.019, OR = 1.20, 95% CI, 1.03–1.40) and age (P = 0.044, OR = 1.07, 95% CI, 1.00–1.14) were also independent factors of global cognitive function.Conclusion: BZD exposure density was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia, but no correlation was found between Z drug use and cognitive impairment. Moreover, the use of Z drugs seemed to be associated with protection for attention. The use for prescription of BZDs, in this case, should be avoided or limited to low doses. Due to the addiction and tolerance, Z drugs should also be prescribed with great caution in middle-aged and elderly patients.

scholarly journals Functional Decline in Cognitive Impairment – The Relationship between Physical and Cognitive Function

2008 ◽  
Vol 31 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Tung Wai Auyeung ◽  
Timothy Kwok ◽  
Jenny Lee ◽  
Ping Chung Leung ◽  
Jason Leung ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Functional Decline ◽  
The Relationship

scholarly journals Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

2020 ◽  
Vol 24 (3) ◽  
pp. 231-240 ◽  
Author(s):  
Yeon Joo Kim ◽  
Bum Sik Tae ◽  
Jae Hyun Bae
Keyword(s):  
Cognitive Impairment ◽  
Urinary Tract ◽  
Cognitive Function ◽  
Lower Urinary Tract Symptoms ◽  
Older Patients ◽  
Lower Urinary Tract ◽  
Anticholinergic Drugs ◽  
Long Term Study ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

scholarly journals Functional Status and Therapy for Nursing Home Residents with Diffuse Large B-Cell Lymphoma: A Population-Based Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1918-1918
Author(s):  
Mengyang Di ◽  
Adam J. Olszewski ◽  
Tamra Keeney ◽  
Emmanuelle Belanger ◽  
Orestis A. Panagiotou
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Research Funding ◽  
Functional Limitations ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Severe Disability ◽  
Medicare Beneficiaries ◽  
Population Based Study ◽  
To Receive

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is a potentially curable cancer, predominantly affecting older patients. Functional limitations and comorbidities make its management challenging among those with advanced age. Approximately 23% of Medicare beneficiaries do not receive curative chemoimmunotherapy (Hamlin et al, Oncologist, 2014), and the treatment rates decrease with increasing age (Williams et al, Cancer, 2015). Treatment may be particularly difficult for older nursing home (NH) residents who are physiologically frail and have significant functional limitations. The goal of this study is to describe patterns of cancer-directed therapies and outcomes among NH residents with DLBCL in the United States and dissect the association between functional impairment and receipt of treatment. Methods: We used the SEER-Medicare registry to identify Medicare beneficiaries diagnosed with DLBCL in 2011-2015, who had Minimum Data Set (MDS) assessments within 120 days prior to diagnosis or treatment. The MDS is routinely performed in NHs and includes multiple geriatric domains, including physical and cognitive function. We used the Morris activities of daily living (ADL) scale to quantify functional limitations in 7 activities (bed mobility, dressing, eating, locomotion on unit, personal hygiene, toileting, and transfers). We characterized limitations based on dependency in ADLs: no disability (0 ADLs), moderate disability (1-4 ADLs), or severe disability (5-7 ADLs). We used the Cognitive Function Scale (CFS) to characterize cognition as intact, mild, or moderate to severe impairment. We used multivariable logistic regression to compare the receipt of chemoimmunotherapy (including receipt of curative multiagent, anthracycline-containing regimen), 30-day mortality, and 30-day hospitalization, respectively, between the NH and non-NH population, reporting the odds ratio (OR) and 95% confidence interval (CI). We used multivariable Cox regression to compare overall survival (OS) between these two populations, reporting hazard ratio (HR) with 95% CI. Within the NH population, we examine the association of receipt of chemotherapy with functional and cognitive impairment, respectively. All models were adjusted for age, sex, race, stage, comorbidities, Medicaid dual coverage, and type of NH stay (long vs. short stay). Results: Among 11,128 patients with DLBCL, 718 received care in NHs (median age 82 years, 59% women, 90% White, 50% stage III/IV disease). Compared with non-NH patients, NH residents were less likely to receive any chemoimmunotherapy (41% vs. 69%, OR: 0.34, 95% CI: 0.29-0.41) or, when treated, curative regimens (47% vs. 71%, OR: 0.51, 95% CI: 0.37-0.72) (Fig. 1A-1B). NH residents had high rates of 30-day mortality after therapy (18% vs. 7%, OR: 1.99, 95% CI: 1.43-2.77) and 30-day hospitalization (58% vs. 43%, OR: 1.51, 95% CI: 1.18-1.93), and had short median OS of 3.7 months (versus 31.7 months for non-NH residents; HR: 1.36, 95% CI: 1.11-1.65) (Fig. 1C). Rates of disability and cognitive impairment were high, 20% had moderate disability, 60% had severe disability and 17-26% had mild or moderate to severe cognitive impairment. Compared with patients with no ADL disability, those with severe disability were less likely to receive any chemoimmunotherapy (38% vs. 50%, OR: 0.58, 95% CI: 0.38-0.89) (Fig. 2A-2B). Compared with those with intact cognitive function, patients with mild (39% vs. 47%, OR: 0.66, 95% CI: 0.45-0.97) and moderate to severe (24% vs. 47%, OR: 0.31, 95% CI: 0.19-0.51) impairment, respectively, were less likely to receive chemoimmunotherapy (Fig. 2C). Conclusions: In this population-based study, over half of NH residents with DLBCL did not receive chemoimmunotherapy, and 47% of chemotherapy recipients received curative regimens. Despite treatment, NH residents had higher rates of early mortality and hospitalization, and short median survival (only 3.7 months). These findings indicate a need for alternative treatment strategies for patients in NHs, particularly those with high levels of disability. Routinely collected NH assessment data revealed strong associations between receipt of chemotherapy, functional limitations, and cognitive impairment among NH residents with DLBCL. These findings suggest that structured assessment of function and cognition may improve patient selection for curative therapy. Figure 1 Figure 1. Disclosures Olszewski: TG Therapeutics: Research Funding; PrecisionBio: Research Funding; Celldex Therapeutics: Research Funding; Genentech, Inc.: Research Funding; Acrotech Pharma: Research Funding; Genmab: Research Funding. Panagiotou: International Consulting Associates, Inc: Other: Personal fees.

scholarly journals How to develop a simply frailty score for predicting postoperative morbidity in cardiac surgery

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Gait Speed ◽  
Albumin Level ◽  
Old Patients ◽  
One Year ◽  
Frailty Score

Introduction: Ageing and elderly people have greater risk. Physical state and frailty status represent an important risk and must be considered before cardiac surgery. More than one third of current surgeries are performed in patients older than 70 years. This is a factor to keep on mind in our routine evaluation. Currently an accepted definition for frailty is not well established. It has been considered as a physiological decline in multiple organ systems, decreasing the patient’s capacity to withstand the stresses of surgery and disease. The aim of our study was to determinate a correlation between preoperative features and the morbidity after cardiac surgery in aortic valve replacement population. Methods: We selected the 70 years old patients or older who underwent an elective aortic valve replacement. We collected prospectively all preoperative features and frailty traits (Barthel Test; Gait Speed test, Handgrip) also taking into account blood parameters like albumin level and hematocrit previous to the surgery, hospital admissions within 6 months, and we analyze the demographics and medical history of the patients. We compare patients who undergo to stented prosthesis, sutureless or Transcatheter prostheses (TAVI) procedure and follow up. Results: Two hundred patients were enrolled. The mean age was 78 years all. The predicted mortality with Logistic euroScore I was 12,8% with a real mortality lower than expected (3,5%). Pre-surgery frailty in our population was associated with a Gait Speed higher of 7 seconds, Barthel less of 90%, anemia with Hematocrit <32%, albumin level< 3,4g/dl, chronic renal failure, preoperative re-admission and artery disease. The TAVI group had higher morbidity, no differences statistically significant between Stented and sutureless prosthesis group. Frail individuals had longer hospital stays, readmissions and respiratory/ infectious complications. The mortality at 6 months /one year follow up was 4,1 % /0 % respectively; and morbidity (pacemaker implant, respiratory events, readmission); at 6 months /one year of follow up was 13,47 % to 3%. Conclusions: Elderly and frailty population present more complications after a cardiac surgery. A simple frailty score must be considered in cardiac population to avoid increased morbidity.

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