External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization

Koichi Morisaki, Tadashi Furuyama, Yutaka Matsubara, Kentaro Inoue, Shun Kurose, Shinichiro Yoshino, Ken Nakayama, Sho Yamashita, Keiji Yoshiya, Ryosuke Yoshiga, Yoshihiko Maehara

Research output: Contribution to journalArticle

Abstract

Objectives: CLI Frailty is a useful diagnostic criterion of frailty in patients with critical limb ischemia (CLI). It is important to evaluate not only comorbidities but also frailty in decision making to select the type of treatment for CLI patients. The purposes of our study were to externally validate the CLI Frailty Index and to evaluate the modified CLI Frailty Index by measurement of skeletal muscle mass using computed tomography. Methods: Patients who underwent preoperative computed tomography examination and infrainguinal revascularization between 2002 and 2015 were retrospectively analyzed. A patient was defined as CLI Frailty (+), if two or more of the following criteria were present: low Geriatric Nutritional Risk Index (GNRI), low skeletal muscle mass index (SMI) evaluated by prediction equations, and non-ambulatory status. For the modified CLI Frailty Index, skeletal muscle area was measured by computed tomography instead of prediction equations. Results: During the study period, 226 patients with CLI underwent revascularization; we included 127 patients and excluded 99 patients who were treated only with iliac revascularization or did not undergo CT scans. The overall survival at two years after revascularization was 83.6% for the CLI Frailty (−) group versus 63.2% for the CLI Frailty (+) group (P =.02). The overall survival at two years after revascularization was 89.7% for the modified CLI Frailty (−) group versus 60.5% for the modified CLI Frailty (+) group (P <.01). Multivariate analysis 1 including CLI Frailty revealed that hemodialysis (HR, 3.71; 95% CI, 1.58–8.83; P <.01), CLI Frailty (HR, 3.22; 95% CI, 1.35–7.47; P <.01) and cerebrovascular disease (HR, 2.58; 95% CI, 1.09–5.91; P =.03) were risk factors for overall survival two years after revascularization. In multivariate analysis 2 including modified CLI Frailty, modified CLI Frailty (HR, 5.92; 95% CI, 2.49–15.7; P <.01), hemodialysis (HR, 4.03; 95% CI, 1.65–10.0; P <.01) and diabetes mellitus (HR, 0.41; 95% CI, 0.16–0.99; P =.05) were risk factors for overall survival two years after revascularization. Conclusions: Both the CLI Frailty and the modified CLI Frailty Indexes were useful in predicting the two-year overall survival of patients with CLI after infrainguinal revascularization. Although the measurement of skeletal muscle mass using computed tomography may accurately predict two-year overall survival, SMI prediction is effective for patients with CLI who did not undergo preoperative CT.

Original languageEnglish
Pages (from-to)405-410
Number of pages6
JournalVascular
Volume27
Issue number4
DOIs
Publication statusPublished - Aug 1 2019

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Ischemia
Extremities
Skeletal Muscle
Survival
Tomography
Renal Dialysis
Multivariate Analysis
Cerebrovascular Disorders
Nutrition Assessment
Geriatrics
Comorbidity
Decision Making
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization. / Morisaki, Koichi; Furuyama, Tadashi; Matsubara, Yutaka; Inoue, Kentaro; Kurose, Shun; Yoshino, Shinichiro; Nakayama, Ken; Yamashita, Sho; Yoshiya, Keiji; Yoshiga, Ryosuke; Maehara, Yoshihiko.

In: Vascular, Vol. 27, No. 4, 01.08.2019, p. 405-410.

Research output: Contribution to journalArticle

Morisaki, Koichi ; Furuyama, Tadashi ; Matsubara, Yutaka ; Inoue, Kentaro ; Kurose, Shun ; Yoshino, Shinichiro ; Nakayama, Ken ; Yamashita, Sho ; Yoshiya, Keiji ; Yoshiga, Ryosuke ; Maehara, Yoshihiko. / External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization. In: Vascular. 2019 ; Vol. 27, No. 4. pp. 405-410.
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title = "External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization",
abstract = "Objectives: CLI Frailty is a useful diagnostic criterion of frailty in patients with critical limb ischemia (CLI). It is important to evaluate not only comorbidities but also frailty in decision making to select the type of treatment for CLI patients. The purposes of our study were to externally validate the CLI Frailty Index and to evaluate the modified CLI Frailty Index by measurement of skeletal muscle mass using computed tomography. Methods: Patients who underwent preoperative computed tomography examination and infrainguinal revascularization between 2002 and 2015 were retrospectively analyzed. A patient was defined as CLI Frailty (+), if two or more of the following criteria were present: low Geriatric Nutritional Risk Index (GNRI), low skeletal muscle mass index (SMI) evaluated by prediction equations, and non-ambulatory status. For the modified CLI Frailty Index, skeletal muscle area was measured by computed tomography instead of prediction equations. Results: During the study period, 226 patients with CLI underwent revascularization; we included 127 patients and excluded 99 patients who were treated only with iliac revascularization or did not undergo CT scans. The overall survival at two years after revascularization was 83.6{\%} for the CLI Frailty (−) group versus 63.2{\%} for the CLI Frailty (+) group (P =.02). The overall survival at two years after revascularization was 89.7{\%} for the modified CLI Frailty (−) group versus 60.5{\%} for the modified CLI Frailty (+) group (P <.01). Multivariate analysis 1 including CLI Frailty revealed that hemodialysis (HR, 3.71; 95{\%} CI, 1.58–8.83; P <.01), CLI Frailty (HR, 3.22; 95{\%} CI, 1.35–7.47; P <.01) and cerebrovascular disease (HR, 2.58; 95{\%} CI, 1.09–5.91; P =.03) were risk factors for overall survival two years after revascularization. In multivariate analysis 2 including modified CLI Frailty, modified CLI Frailty (HR, 5.92; 95{\%} CI, 2.49–15.7; P <.01), hemodialysis (HR, 4.03; 95{\%} CI, 1.65–10.0; P <.01) and diabetes mellitus (HR, 0.41; 95{\%} CI, 0.16–0.99; P =.05) were risk factors for overall survival two years after revascularization. Conclusions: Both the CLI Frailty and the modified CLI Frailty Indexes were useful in predicting the two-year overall survival of patients with CLI after infrainguinal revascularization. Although the measurement of skeletal muscle mass using computed tomography may accurately predict two-year overall survival, SMI prediction is effective for patients with CLI who did not undergo preoperative CT.",
author = "Koichi Morisaki and Tadashi Furuyama and Yutaka Matsubara and Kentaro Inoue and Shun Kurose and Shinichiro Yoshino and Ken Nakayama and Sho Yamashita and Keiji Yoshiya and Ryosuke Yoshiga and Yoshihiko Maehara",
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T1 - External validation of CLI Frailty Index and assessment of predictive value of modified CLI Frailty Index for patients with critical limb ischemia undergoing infrainguinal revascularization

AU - Morisaki, Koichi

AU - Furuyama, Tadashi

AU - Matsubara, Yutaka

AU - Inoue, Kentaro

AU - Kurose, Shun

AU - Yoshino, Shinichiro

AU - Nakayama, Ken

AU - Yamashita, Sho

AU - Yoshiya, Keiji

AU - Yoshiga, Ryosuke

AU - Maehara, Yoshihiko

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objectives: CLI Frailty is a useful diagnostic criterion of frailty in patients with critical limb ischemia (CLI). It is important to evaluate not only comorbidities but also frailty in decision making to select the type of treatment for CLI patients. The purposes of our study were to externally validate the CLI Frailty Index and to evaluate the modified CLI Frailty Index by measurement of skeletal muscle mass using computed tomography. Methods: Patients who underwent preoperative computed tomography examination and infrainguinal revascularization between 2002 and 2015 were retrospectively analyzed. A patient was defined as CLI Frailty (+), if two or more of the following criteria were present: low Geriatric Nutritional Risk Index (GNRI), low skeletal muscle mass index (SMI) evaluated by prediction equations, and non-ambulatory status. For the modified CLI Frailty Index, skeletal muscle area was measured by computed tomography instead of prediction equations. Results: During the study period, 226 patients with CLI underwent revascularization; we included 127 patients and excluded 99 patients who were treated only with iliac revascularization or did not undergo CT scans. The overall survival at two years after revascularization was 83.6% for the CLI Frailty (−) group versus 63.2% for the CLI Frailty (+) group (P =.02). The overall survival at two years after revascularization was 89.7% for the modified CLI Frailty (−) group versus 60.5% for the modified CLI Frailty (+) group (P <.01). Multivariate analysis 1 including CLI Frailty revealed that hemodialysis (HR, 3.71; 95% CI, 1.58–8.83; P <.01), CLI Frailty (HR, 3.22; 95% CI, 1.35–7.47; P <.01) and cerebrovascular disease (HR, 2.58; 95% CI, 1.09–5.91; P =.03) were risk factors for overall survival two years after revascularization. In multivariate analysis 2 including modified CLI Frailty, modified CLI Frailty (HR, 5.92; 95% CI, 2.49–15.7; P <.01), hemodialysis (HR, 4.03; 95% CI, 1.65–10.0; P <.01) and diabetes mellitus (HR, 0.41; 95% CI, 0.16–0.99; P =.05) were risk factors for overall survival two years after revascularization. Conclusions: Both the CLI Frailty and the modified CLI Frailty Indexes were useful in predicting the two-year overall survival of patients with CLI after infrainguinal revascularization. Although the measurement of skeletal muscle mass using computed tomography may accurately predict two-year overall survival, SMI prediction is effective for patients with CLI who did not undergo preoperative CT.

AB - Objectives: CLI Frailty is a useful diagnostic criterion of frailty in patients with critical limb ischemia (CLI). It is important to evaluate not only comorbidities but also frailty in decision making to select the type of treatment for CLI patients. The purposes of our study were to externally validate the CLI Frailty Index and to evaluate the modified CLI Frailty Index by measurement of skeletal muscle mass using computed tomography. Methods: Patients who underwent preoperative computed tomography examination and infrainguinal revascularization between 2002 and 2015 were retrospectively analyzed. A patient was defined as CLI Frailty (+), if two or more of the following criteria were present: low Geriatric Nutritional Risk Index (GNRI), low skeletal muscle mass index (SMI) evaluated by prediction equations, and non-ambulatory status. For the modified CLI Frailty Index, skeletal muscle area was measured by computed tomography instead of prediction equations. Results: During the study period, 226 patients with CLI underwent revascularization; we included 127 patients and excluded 99 patients who were treated only with iliac revascularization or did not undergo CT scans. The overall survival at two years after revascularization was 83.6% for the CLI Frailty (−) group versus 63.2% for the CLI Frailty (+) group (P =.02). The overall survival at two years after revascularization was 89.7% for the modified CLI Frailty (−) group versus 60.5% for the modified CLI Frailty (+) group (P <.01). Multivariate analysis 1 including CLI Frailty revealed that hemodialysis (HR, 3.71; 95% CI, 1.58–8.83; P <.01), CLI Frailty (HR, 3.22; 95% CI, 1.35–7.47; P <.01) and cerebrovascular disease (HR, 2.58; 95% CI, 1.09–5.91; P =.03) were risk factors for overall survival two years after revascularization. In multivariate analysis 2 including modified CLI Frailty, modified CLI Frailty (HR, 5.92; 95% CI, 2.49–15.7; P <.01), hemodialysis (HR, 4.03; 95% CI, 1.65–10.0; P <.01) and diabetes mellitus (HR, 0.41; 95% CI, 0.16–0.99; P =.05) were risk factors for overall survival two years after revascularization. Conclusions: Both the CLI Frailty and the modified CLI Frailty Indexes were useful in predicting the two-year overall survival of patients with CLI after infrainguinal revascularization. Although the measurement of skeletal muscle mass using computed tomography may accurately predict two-year overall survival, SMI prediction is effective for patients with CLI who did not undergo preoperative CT.

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