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. 2023 Sep 12;12(18):5927.
doi: 10.3390/jcm12185927.

A Novel Frailty Score Based on Laboratory Parameters (FIMS Score) for the Management of Older Patients with Severe Aortic Stenosis

Augusto Esposito  1 , Ilenia Foffa  2   3 , Luca Bastiani  2   3 , Cecilia Vecoli  2   3 , Antonio Rizza  1 , Simona Storti  3 , Alberto Ranieri De Caterina  1 , Annamaria Mazzone  3 , Sergio Berti  1   2
Affiliations

A Novel Frailty Score Based on Laboratory Parameters (FIMS Score) for the Management of Older Patients with Severe Aortic Stenosis

Augusto Esposito et al. J Clin Med. .

Abstract

This study aimed to develop a novel score based on common laboratory parameters able to identify frail and sarcopenic patients as well as predict mortality in elderly patients with severe aortic stenosis (AS) for tailored clinical decision-making. A total of 109 patients (83 ± 5 years; females, 68%) with AS underwent a multidisciplinary pre-operative assessment and finalized a "frailty-based management" for the AS interventional treatment. Laboratory parameters of statistically significant differences between sarcopenic and non-sarcopenic individuals were tested in the structural equation model (SEM) to build a Frailty Inflammation Malnutrition and Sarcopenia score (FIMS score). Mortality at 20 months of follow-up was considered an outcome. FIMS score, in particular, the cut-off value ≥ 1.28 was able to identify "frail" and "early frail" patients and predict mortality with a sensitivity of 83.3% and 82.6%, respectively (p = 0.001) and was an independent determinant associated with a higher risk of mortality (HR 5.382; p-value = 0.002). The FIMS score, easily achievable and usable in clinical practice, was able to identify frail and sarcopenic patients as well as predict their adverse clinical outcomes. This score could provide appropriate guidance during decision-making regarding elderly patients with severe AS.

Keywords: TAVR; aortic stenosis; frailty; outcome; sarcopenia; score.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Standardized factor loading values of the single factor model of Sarcopenia. The FIMS score, following the structural equation model analysis, represents the weighted sums of the values of selected clinical chemistry laboratory parameters. The score has been rescaled to a range of 0–10 using the following formula: 10 × (FIMS − min)/(max − min). The goodness-of-fit indices are as follows: a standardized root mean square residual of 0.052 and a root mean square error of approximation of 0.072. * Statistical level of significance p-value < 0.05.
Figure 2
Figure 2
FIMS score and frailty (A) The median FIMS score between classes of frailty (B) A graphic representation of the median value of the FIMS score between classes of fragility and the relationship between laboratory parameters and malnutrition, inflammation, and sarcopenia in frailty patients with severe AS (C) ROC curve of FIMS score diagnostic accuracy for frailty.
Figure 3
Figure 3
Graphic representation of FIMS factor scores between types of treatment.
Figure 4
Figure 4
ROC curve of FIMS score for adverse outcome prediction.
See this image and copyright information in PMC

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