Sven M Piepenburg, Mariya Maslarska, Christian Weber, Klaus Kaier, Constantin von Zur Mühlen, Dirk Westermann, Christoph Hehrlein
{"title":"Hospital frailty risk and CHA2DS2-VA scores in the mortality assessment of older patients with peripheral artery disease.","authors":"Sven M Piepenburg, Mariya Maslarska, Christian Weber, Klaus Kaier, Constantin von Zur Mühlen, Dirk Westermann, Christoph Hehrlein","doi":"10.1024/0301-1526/a001183","DOIUrl":null,"url":null,"abstract":"<p><p><b></b> <i>Background:</i> Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. <i>Patients and methods:</i> This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA<sub>2</sub>DS<sub>2</sub>-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA<sub>2</sub>DS<sub>2</sub>-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA<sub>2</sub>DS<sub>2</sub>-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. <i>Conclusions:</i> HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA<sub>2</sub>DS<sub>2</sub>-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA<sub>2</sub>DS<sub>2</sub>-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.</p>","PeriodicalId":23528,"journal":{"name":"Vasa-european Journal of Vascular Medicine","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vasa-european Journal of Vascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1024/0301-1526/a001183","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Older patients with peripheral artery disease (PAD) encounter an increased risk of in-hospital mortality. Accurate risk scoring methods are crucial for assessing the likelihood of cardiovascular events in these patients. However, a comprehensive comparison of these scoring methods for predicting in-hospital mortality in PAD patients has not yet been conducted. Patients and methods: This study analyzed 173,075 patients hospitalized with PAD in the year 2020 from a German nationwide registry. We assessed five risk scores: the Elixhauser Comorbidity Index, the Charlson Comorbidity Index, the CHA2DS2-VA Score, the EuroSCORE, and the Hospital Frailty Risk Score (HFRS). The average patient age was 72 ± 10.94 years, with 36.82% female and 35.27% also diagnosed with diabetes mellitus. The overall in-hospital mortality rate was 2.68%. Mean scores were 7.12±6.55 for the Elixhauser Comorbidity Index, 2.66±1.72 for the Charlson Comorbidity Index, 3.85±1.43 for the CHA2DS2-VA Score, 8.96%±8.85% for the EuroSCORE, and 3.53±5 for the HFRS. The HFRS showed the highest predictive potential for in-hospital mortality with an area under the curve (AUC) of 0.86 (95% confidence interval (CI): 0.86-0.87) but had the worst calibration for high-risk patients. The CHA2DS2-VA Score had the lowest AUC 0.69 (95% CI: 0.68-0.70) but was the most consistent prediction model regarding calibration. Conclusions: HFRS was the most effective overall predictor of in-hospital mortality, but did not detect those patients with a very high risk of mortality. The CHA2DS2-VA Score was the most robust predictor of increasing score points but had the lowest sensitivity. Therefore, use of the HFRS combined with application of the CHA2DS2-VA Score appears to be most appropriate in identifying older PAD patients at risk of in-hospital mortality.
期刊介绍:
Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology.
The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation.
Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.