Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization

Lorena Gonzalez, Mohammed Kassem, Arthur Owora, Marc T. Seligson, Camille Y. Richards, Monique M. Monita, Sylvia Z. Cardounell, Sharon A. Brangman, Vivian Gahtan

Research output: Contribution to journalArticle

Abstract

Background: Frailty predicts poor outcome after vascular surgery. We determined the predictive utility of the modified frailty index (mFI) after first-time revascularization and identified biomarkers of frailty predictive of outcome in veterans with peripheral arterial disease. Methods: A retrospective study was performed of first-time revascularizations (open surgery [OS] and endovascular surgery [ES]) in male veterans (2003-2016). Preoperative mFI scores were calculated, and serum and nonserum biomarkers of frailty were recorded. The primary endpoint was 2-y incidence of reintervention, amputation, and mortality. Secondary endpoints included 30-day morbidity and readmissions. Results: Four hundred and thirty one patients (OS, n = 188; ES, n = 243), mean age of 66 ± 9 y, and 16 mo of median follow-up were studied. Mean mFI was 0.39 ± 0.16 for OS and 0.38 ± 0.15 for ES (P = 0.43). 30-day complications (adjusted odds ratio, 4.89; 95% confidence interval [CI]: 1.67-14.33) and readmissions (adjusted hazard ratio [aHR] 3.32; 95% CI: 1.16-9.55) were increased in the OS versus ES group when stratified by mFI. Survival analysis showed a correlation between risk of amputation, death, and composite outcome with increasing mFI (P < 0.005) in both groups. Frailty independently predicted major amputation (aHR 2.16; 1.06-4.39), mortality (aHR 2.62; 95% CI: 1.17-5.88), and composite outcome (aHR 1.97; 95% CI: 1.06-3.68) when the groups are combined. Except for absolute neutrophil count, all preoperative lab values correlated with mFI (P < 0.5). Higher albumin was independently associated with lower risk of amputation (aHR: 0.58 [0.36-0.94]) and mortality (aHR: 0.45 [0.25-0.83]); higher hemoglobin predicted limb salvage (aHR 0.7 [0.62-0.84]). Conclusions: Frailty predicts short- and long-term outcomes after first-time revascularization in veterans. Hypoalbuminemia and anemia are associated with higher mFI and independently predict poor outcome, suggesting albumin and hemoglobin are viable biomarkers of frailty in veterans.

Original languageEnglish (US)
Pages (from-to)539-552
Number of pages14
JournalJournal of Surgical Research
Volume243
DOIs
StatePublished - Nov 1 2019

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Veterans
Biomarkers
Amputation
Confidence Intervals
Mortality
Albumins
Hemoglobins
Hypoalbuminemia
Limb Salvage
Peripheral Arterial Disease
Survival Analysis
Blood Vessels
Anemia
Neutrophils
Retrospective Studies
Odds Ratio
Morbidity
Incidence
Serum

Keywords

  • Amputation
  • Biomarkers
  • Frailty
  • PAD
  • Revascularization
  • Veteran

ASJC Scopus subject areas

  • Surgery

Cite this

Gonzalez, L., Kassem, M., Owora, A., Seligson, M. T., Richards, C. Y., Monita, M. M., ... Gahtan, V. (2019). Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization. Journal of Surgical Research, 243, 539-552. https://doi.org/10.1016/j.jss.2019.06.040

Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization. / Gonzalez, Lorena; Kassem, Mohammed; Owora, Arthur; Seligson, Marc T.; Richards, Camille Y.; Monita, Monique M.; Cardounell, Sylvia Z.; Brangman, Sharon A.; Gahtan, Vivian.

In: Journal of Surgical Research, Vol. 243, 01.11.2019, p. 539-552.

Research output: Contribution to journalArticle

Gonzalez, L, Kassem, M, Owora, A, Seligson, MT, Richards, CY, Monita, MM, Cardounell, SZ, Brangman, SA & Gahtan, V 2019, 'Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization', Journal of Surgical Research, vol. 243, pp. 539-552. https://doi.org/10.1016/j.jss.2019.06.040
Gonzalez, Lorena ; Kassem, Mohammed ; Owora, Arthur ; Seligson, Marc T. ; Richards, Camille Y. ; Monita, Monique M. ; Cardounell, Sylvia Z. ; Brangman, Sharon A. ; Gahtan, Vivian. / Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization. In: Journal of Surgical Research. 2019 ; Vol. 243. pp. 539-552.
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abstract = "Background: Frailty predicts poor outcome after vascular surgery. We determined the predictive utility of the modified frailty index (mFI) after first-time revascularization and identified biomarkers of frailty predictive of outcome in veterans with peripheral arterial disease. Methods: A retrospective study was performed of first-time revascularizations (open surgery [OS] and endovascular surgery [ES]) in male veterans (2003-2016). Preoperative mFI scores were calculated, and serum and nonserum biomarkers of frailty were recorded. The primary endpoint was 2-y incidence of reintervention, amputation, and mortality. Secondary endpoints included 30-day morbidity and readmissions. Results: Four hundred and thirty one patients (OS, n = 188; ES, n = 243), mean age of 66 ± 9 y, and 16 mo of median follow-up were studied. Mean mFI was 0.39 ± 0.16 for OS and 0.38 ± 0.15 for ES (P = 0.43). 30-day complications (adjusted odds ratio, 4.89; 95{\%} confidence interval [CI]: 1.67-14.33) and readmissions (adjusted hazard ratio [aHR] 3.32; 95{\%} CI: 1.16-9.55) were increased in the OS versus ES group when stratified by mFI. Survival analysis showed a correlation between risk of amputation, death, and composite outcome with increasing mFI (P < 0.005) in both groups. Frailty independently predicted major amputation (aHR 2.16; 1.06-4.39), mortality (aHR 2.62; 95{\%} CI: 1.17-5.88), and composite outcome (aHR 1.97; 95{\%} CI: 1.06-3.68) when the groups are combined. Except for absolute neutrophil count, all preoperative lab values correlated with mFI (P < 0.5). Higher albumin was independently associated with lower risk of amputation (aHR: 0.58 [0.36-0.94]) and mortality (aHR: 0.45 [0.25-0.83]); higher hemoglobin predicted limb salvage (aHR 0.7 [0.62-0.84]). Conclusions: Frailty predicts short- and long-term outcomes after first-time revascularization in veterans. Hypoalbuminemia and anemia are associated with higher mFI and independently predict poor outcome, suggesting albumin and hemoglobin are viable biomarkers of frailty in veterans.",
keywords = "Amputation, Biomarkers, Frailty, PAD, Revascularization, Veteran",
author = "Lorena Gonzalez and Mohammed Kassem and Arthur Owora and Seligson, {Marc T.} and Richards, {Camille Y.} and Monita, {Monique M.} and Cardounell, {Sylvia Z.} and Brangman, {Sharon A.} and Vivian Gahtan",
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T1 - Frailty and Biomarkers of Frailty Predict Outcome in Veterans After Open and Endovascular Revascularization

AU - Gonzalez, Lorena

AU - Kassem, Mohammed

AU - Owora, Arthur

AU - Seligson, Marc T.

AU - Richards, Camille Y.

AU - Monita, Monique M.

AU - Cardounell, Sylvia Z.

AU - Brangman, Sharon A.

AU - Gahtan, Vivian

PY - 2019/11/1

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N2 - Background: Frailty predicts poor outcome after vascular surgery. We determined the predictive utility of the modified frailty index (mFI) after first-time revascularization and identified biomarkers of frailty predictive of outcome in veterans with peripheral arterial disease. Methods: A retrospective study was performed of first-time revascularizations (open surgery [OS] and endovascular surgery [ES]) in male veterans (2003-2016). Preoperative mFI scores were calculated, and serum and nonserum biomarkers of frailty were recorded. The primary endpoint was 2-y incidence of reintervention, amputation, and mortality. Secondary endpoints included 30-day morbidity and readmissions. Results: Four hundred and thirty one patients (OS, n = 188; ES, n = 243), mean age of 66 ± 9 y, and 16 mo of median follow-up were studied. Mean mFI was 0.39 ± 0.16 for OS and 0.38 ± 0.15 for ES (P = 0.43). 30-day complications (adjusted odds ratio, 4.89; 95% confidence interval [CI]: 1.67-14.33) and readmissions (adjusted hazard ratio [aHR] 3.32; 95% CI: 1.16-9.55) were increased in the OS versus ES group when stratified by mFI. Survival analysis showed a correlation between risk of amputation, death, and composite outcome with increasing mFI (P < 0.005) in both groups. Frailty independently predicted major amputation (aHR 2.16; 1.06-4.39), mortality (aHR 2.62; 95% CI: 1.17-5.88), and composite outcome (aHR 1.97; 95% CI: 1.06-3.68) when the groups are combined. Except for absolute neutrophil count, all preoperative lab values correlated with mFI (P < 0.5). Higher albumin was independently associated with lower risk of amputation (aHR: 0.58 [0.36-0.94]) and mortality (aHR: 0.45 [0.25-0.83]); higher hemoglobin predicted limb salvage (aHR 0.7 [0.62-0.84]). Conclusions: Frailty predicts short- and long-term outcomes after first-time revascularization in veterans. Hypoalbuminemia and anemia are associated with higher mFI and independently predict poor outcome, suggesting albumin and hemoglobin are viable biomarkers of frailty in veterans.

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KW - Amputation

KW - Biomarkers

KW - Frailty

KW - PAD

KW - Revascularization

KW - Veteran

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