Evaluating the impact of frailty in older adults on functional outcomes post-mechanical thrombectomy: a multicentre study incorporating traditional and machine learning methods.
Jul 2026· Journal of Thrombosis and Thrombolysis· 0 citations· 30 references
Medicine
TL;DR
Frailty had the highest feature importance and the second-highest Shapley value and the CFS is an effective prognostication tool for older adults undergoing endovascular thrombectomy.
AIM
Frailty is increasingly recognised as an age-independent predictor of adverse outcomes in cardiovascular disease, yet it is rarely assessed in acute coronary syndrome (ACS) due to practical limitations. This study examined the prognostic significance of frailty, assessed using a laboratory-based frailty index (FI-Lab), in patients with ACS undergoing percutaneous coronary intervention (PCI).
METHODS AND RESULTS
We conducted a multicentre retrospective cohort study across five Korean hospitals using the Observational Medical Outcomes Partnership Common Data Model. Adult patients (≥18 years) who underwent PCI for ACS were included. Frailty status was determined as FI-Lab ≥ 0.4, calculated as the proportion of deficits across 28 routine laboratory variables, with inclusion restricted to patients having at least 70% of laboratory values available. Propensity score matching (1:1) and cox proportional hazards regression were employed to examine the relationships between frailty and clinical outcomes including recurrent acute myocardial infarction, hospital readmissions, and all-cause mortality. Of 5,405 patients, 25.2% were classified as frail. After matching, 929 pairs were analysed. Frailty was significantly associated with hospital readmission (HR 1.946; 95% CI 1.635-2.316) and all-cause mortality (HR 3.675; 95% CI 2.680-5.038), but not with recurrent AMI (HR 0.995; 95% CI 0.854-1.160). Subgroup analyses confirmed consistent associations across age and sex, with robust links to mortality in patients ≥65 years.
CONCLUSION
Frailty, as assessed by FI-Lab, independently predicted hospital readmission and mortality after PCI in patients with ACS. Automated, laboratory-based frailty screening is feasible in acute settings and supports its integration into cardiovascular nursing for early risk stratification and personalised care.
Sujin Gan, E. Seo, Sang Youl Rhee et al.· European Journal of Cardiova...· 0 citations
Integrating serum albumin, hematocrit, BMI, spinal region, and procedure type with frailty indices enhances risk stratification and informs surgical planning, preoperative optimization, and patient counseling in this vulnerable population of patients.
A. Ghaith, Xinlan Yang, Yazan Alasadi et al.· European spine journal· 0 citations
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is the standard treatment for older adults with symptomatic severe aortic stenosis. While cardiovascular predictors of long-term mortality after TAVR are well established, the impact of geriatric factors beyond short-term outcomes remains poorly defined. The main objective was to evaluate the association between geriatric factors and five-year all-cause mortality in patients aged 75 years and older undergoing TAVR.
METHODS
This study is a single-center retrospective analysis of prospectively collected data at Nantes University Hospital, France. All consecutive patients aged ≥ 75 years who underwent TAVR between January 2012 and December 2018 and received a standardized pre-procedural geriatric assessment were included. Geriatric assessment included nutritional status, physical performance, functional status, cognition, comorbidities, and frailty assessed using the Rockwood Clinical Frailty Scale (CFS). Multivariate cox regression was used to identify factors independently associated with mortality.
RESULTS
Among 976 patients included, median age was 84 years and 48% were men. Five-year mortality was 46%. In multivariate analysis, frailty assessed by the CFS was independently but modestly associated with five-year mortality (HR 1.12; 95% CI 1.01-1.26). No other geriatric variables were independently associated with five-year mortality. Five-year mortality increased across frailty categories, from 38% in robust patients to 55% in severely frail patients (p = 0.005).
CONCLUSION
Among patients aged 75 years and older undergoing TAVR, frailty assessed by Rockwood's CFS was the most robust geriatric predictor of five-year mortality. These findings support the integration of frailty assessment into long-term prognostic evaluation and highlight the potential value of combined cardiology and geriatric follow-up after TAVR.
J. Huet, Mélissa Sabin, T. Le Tourneau et al.· Journal of The American Geri...· 0 citations
Background Frailty remains a significant risk factor for adverse health outcomes in hospitalized patients. Few have evaluated frailty risk and its influencing factors in heart failure (HF) patients with acute infections, and previous machine learning models have predominantly overlooked the incorporation of visualization techniques. This study aims to investigate frailty risk factors in this population and develop an interpretable prediction model for frailty. Methods This study enrolled 1498 patients hospitalized for HF with acute infections at Nanjing First Hospital in 2023. Participants were randomly divided into training and testing sets at a 7:3 ratio. Potential predictors were screened through univariate analysis and the least absolute shrinkage and selection operator (LASSO) regression. Eight machine learning algorithms were evaluated to determine the optimal predictive model. Model interpretability was enhanced using the SHapley Additive exPlanations (SHAP) method. Results Frailty was prevalent in 80.3% of the cohort. Key predictors included the use of thiazide diuretics, serum albumin, estimated glomerular filtration rate (eGFR), lymphocyte percentage, mean corpuscular hemoglobin concentration (MCHC), capacity for action, age, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, history of cerebral infarction, and smoking. Comparative analysis of the eight models revealed that eXtreme Gradient Boosting (XGBoost) achieved superior performance, with the highest area under the receiver operating characteristic curve (AUROC: 0.872) and precision-recall curve (AUPRC: 0.969). Conclusions This study identified the use of thiazide diuretics as an independent predictor associated with lower frailty probability. We developed an online calculator as a proof-of-concept tool to demonstrate the potential application of the predictive model and facilitate real-time risk estimation.
Introduction Stroke-associated pneumonia (SAP) is a common and serious complication in patients with acute severe stroke, and existing risk assessment tools have limited predictive accuracy in critically ill populations. This study innovatively incorporated frailty and nutritional risk, which reflect stress tolerance and overall physiological reserve, into an early SAP prediction model. Methods A retrospective cohort study was conducted on 293 critically ill stroke patients admitted to the Neurocritical Care Unit of the First Affiliated Hospital of Chongqing Medical University between 2013 and 2024. Collect clinical characteristics and laboratory indicators of patients, assess their frailty status and nutritional risk, and analyze the additive interaction effect between the two on the occurrence of SAP. Independent predictors were identified through multivariate logistic regression and incorporated into a visual nomogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis, and 10-fold cross-validation. Results A total of 293 patients with severe stroke were included in this study, among whom 126 (43%) developed SAP. The results of the additive interaction analysis showed a positive additive interaction between frailty and nutritional risk in the development of SAP, with an attributable proportion (AP) of 0.711 (95% CI = 0.358 ~ 1.065) and a synergy index (SI) of 3.694 (95% CI = 1.200 ~ 11.364). A SAP risk prediction model incorporating age, nasogastric tube use, neutrophil-to-lymphocyte ratio (NLR), frailty status, and nutritional risk demonstrated good discriminative performance, with an area under the curve (AUC) of 0.848, which was significantly higher than that of the conventional SAP prediction score (ISAN score: AUC = 0.589). Internal validation showed that the model achieved an accuracy of 73.93%, sensitivity of 77.30%, and specificity of 71.95%, indicating good stability. The calibration curve demonstrated good agreement between predicted and observed outcomes. Decision curve analysis (DCA) indicated that the model provided substantially greater clinical net benefit than the ISAN score. Discussion This study is the first to integrate frailty and nutritional risk into an SAP prediction model, significantly improving early risk identification and providing an innovative, practical tool for precision prevention and targeted intervention in critically ill stroke patients.
Kailibinuer Aimaier, Jia-Rui Xiong, Chunrui Liu et al.· Frontiers in Neurology· 0 citations
OBJECTIVE
To evaluate the combined predictive value of the frailty index (FI) and prognostic nutritional index (PNI) for prognosis in elderly hip fracture patients.
METHODS
Clinical data from 110 elderly hip fracture patients were prospectively analyzed with 1-year postoperative follow-up. Patients were stratified into survival (n = 76) and non-survival (n = 34) groups based on outcomes. Collected parameters included demographic characteristics, fracture patterns, treatment modalities, and laboratory indices. Receiver operating characteristic curve analysis assessed the predictive efficacy of FI and PNI individually and combined. Optimal cutoff values were determined for patient stratification. Kaplan-Meier analysis evaluated 1-year survival rates, while Cox proportional hazards modeling identified prognostic factors.
RESULTS
Significant intergroup differences (P < .05) were observed for body mass index, intraoperative transfusion rates, American Society of Anesthesiologists classification, frailty prevalence, FI values, lymphocyte counts, albumin levels, and C-reactive protein (CRP). The nonsurvival group demonstrated significantly lower PNI (P < .05). Receiver operating characteristic analysis yielded area under the curve values of 0.713 (FI), 0.782 (PNI), and 0.816 (combined). Patients with high FI/low PNI showed the poorest 1-year survival. Multivariate analysis identified decreased lymphocyte counts and PNI, along with elevated CRP and FI, as independent risk factors for adverse outcomes (P < .05).
CONCLUSION
The FI-PNI combination provides superior prognostic accuracy for elderly hip fracture patients, reflecting comprehensive pathophysiological changes. Key independent risk factors include lymphopenia, hypoalbuminemia, elevated CRP, and increased FI. Routine frailty and nutritional assessments should guide personalized care plans to optimize outcomes.
