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. 2024 Nov 5;13(21):e036963.
doi: 10.1161/JAHA.124.036963. Epub 2024 Nov 4.

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Critical Limb-Threatening Ischemia and End-Stage Kidney Disease

Monil Majmundar  1 , Wan-Chi Chan  1 , Vivek Bhat  2 , Kunal N Patel  1 , Kirk A Hance  3 , Georges Hajj  1 , Axel Thors  3 , Kamal Gupta  1
Affiliations

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Critical Limb-Threatening Ischemia and End-Stage Kidney Disease

Monil Majmundar et al. J Am Heart Assoc. .

Abstract

Background: End-stage kidney disease (ESKD) is commonly associated with critical limb-threatening ischemia (CLTI) and frailty. Yet there are no specific tools to predict outcomes of CLTI in ESKD, particularly those that incorporate frailty. We aimed to assess the utility of the medical record-based Hospital Frailty Risk (HFR) score in predicting outcomes of CLTI in ESKD.

Methods and results: We identified patients with ESKD diagnosed with CLTI from the US Renal Data System from 2015 to 2018. These patients were categorized into 3 frailty risk groups on the basis of their HFR scores: low (<5), intermediate (5-10), high-risk (>10), and on the basis of whether they underwent revascularization (endovascular revascularization [ER]/surgical revascularization [SR]) or not (no revascularization). Primary outcomes of interest included in-hospital composite of death or major amputation and in-hospital death. We included 49 454 eligible patients, with ER/SR cohort including 19.8% (n=9777). A total of 88.4% (ER/SR) and 90.0% (no revascularization) were frail on the HFR scale. We found a nonlinear association between HFR score and in-hospital adverse outcomes. In both cohorts, intermediate and high-risk HFR scores were associated with greater risk of in-hospital death (high-risk, ER/SR: odds ratio, 2.7 [95% CI, 1.6-4.8]; P<0.0001; no revascularization: odds ratio, 7.8 [95% CI, 5.3-11.6]; P<0.01) and composite of in-hospital major amputation or death (high-risk, ER/SR: odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.0001; no revascularization: odds ratio, 1.7 [95% CI, 1.5-1.9]; P<0.0001).

Conclusions: The HFR score can predict risk of in-hospital death and composite of death or major amputation in patients with ESKD and CLTI. Further data are needed to determine the utility of the HFR score in this population.

Keywords: critical limb threatening ischemia; end stage kidney disease; frailty; major amputation; peripheral artery disease; revascularization.

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Figures

Figure 1
Figure 1. Patient selection flowchart.
ESKD indicates end‐stage kidney disease; ICD‐10, International Classification of Diseases, Tenth Revision; and USRDS, United States Renal Database System.
Figure 2
Figure 2. Relationship of HFR score with in‐hospital amputation or mortality (A) and in‐hospital death (B) in patients with ESKD undergoing revascularization or no revascularization for critical limb‐threatening ischemia.
Nonlinear increasing trends for these outcomes against HFR score on restricted cubic spline curves; both intermediate‐ and high‐risk HFR scores correlated with risk of these outcomes. ESKD indicates end‐stage kidney disease; and HFR, Hospital Frailty Risk.
Figure 3
Figure 3. Relationship of HFR score with 1‐year amputation or mortality (A) and 1‐year death (B) in patients with ESKD undergoing revascularization or no revascularization for critical limb‐threatening ischemia.
Nonlinear increasing trends for these outcomes against HFR score on restricted cubic spline curves; while high‐risk HFR correlated with greater risk of these outcomes, intermediate‐risk HFR lacked association. ESKD indicates end‐stage kidney disease; and HFR, Hospital Frailty Risk.
See this image and copyright information in PMC

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