FRAILTY AND INFLAMMATION AS PREDICTORS OF MORTALITY IN PATIENTS UNDERGOING ELECTIVE CARDIAC SURGERY
Author(s)
Ammar Jaber, MSc1, Ali Al-Murshedi, MSc1, Rudolf Kiss, MD, PhD2, József Betlehem, PhD, habil3, Annamaria Pakai, MSc, RN, PhD, habil.4, Zsófia Verzár, MD, PhD Habil5;
1University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 2University of Pécs, Heart Institute, Medical School, Pécs, Hungary, 3University of Pécs, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary, 4University of Pécs, Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary, 5University of Pécs, Intézet: Institute of Emergency Care, Pedagogy of Health and Nursing Sciences,Doctoral School of Hea, Pécs, Hungary
1University of Pécs, Doctoral School of Health Sciences, Pécs, Hungary, 2University of Pécs, Heart Institute, Medical School, Pécs, Hungary, 3University of Pécs, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary, 4University of Pécs, Faculty of Health Sciences, Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, Pécs, Hungary, 5University of Pécs, Intézet: Institute of Emergency Care, Pedagogy of Health and Nursing Sciences,Doctoral School of Hea, Pécs, Hungary
OBJECTIVES: To investigate whether combining frailty assessment and perioperative inflammatory/nutritional biomarkers with the EuroSCORE improves the prediction of postoperative mortality and severe complications in patients undergoing major elective cardiac surgery.
METHODS: This observational, prospective, single-center study, conducted between (January 5, 2023) and (May 10, 2024) at the Department of Cardiac Surgery, Heart Institute, Pécs, Hungary, enrolled 40 patients undergoing major elective cardiac surgery, coronary artery bypass grafting, valve replacement/repair, or combined procedures. The patients were stratified into three categories (non-frail, pre-frail, and frail). Biomarker sampling was performed preoperatively (baseline) and on postoperative days 1, 2, and 6. The primary endpoint was a composite of in-hospital mortality and postoperative complications, including sepsis, graft occlusion, acute renal failure, and stroke. Logistic regression and random forest classifiers were used to model the primary outcomes.
RESULTS: Frail patients exhibited significantly higher IL-6 and CRP levels and lower IGF-1 levels than non-frail and pre-frail patients. The EuroSCORE alone had limited discriminatory power (AUC = 0.62). The predictive accuracy improved with the addition of EFS (AUC = 0.75), and the random forest model incorporating biomarkers further increased the accuracy (AUC = 0.80). Spearman’s correlations showed moderate associations between EFS and IL-6 (r = 0.43), CRP (r = 0.36), and IGF-1 (r = − 0.41).
CONCLUSIONS: Combining frailty assessment, inflammatory/nutritional biomarkers, and traditional surgical risk scoring yields a more accurate prediction of postoperative mortality and complications in patients undergoing cardiac surgery than EuroSCORE alone. Elevated IL-6 and CRP levels, together with reduced IGF-1 concentrations, are closely associated with frailty and adverse outcomes, highlighting the pivotal role of preoperative inflammatory and nutritional status in shaping recovery trajectories.
METHODS: This observational, prospective, single-center study, conducted between (January 5, 2023) and (May 10, 2024) at the Department of Cardiac Surgery, Heart Institute, Pécs, Hungary, enrolled 40 patients undergoing major elective cardiac surgery, coronary artery bypass grafting, valve replacement/repair, or combined procedures. The patients were stratified into three categories (non-frail, pre-frail, and frail). Biomarker sampling was performed preoperatively (baseline) and on postoperative days 1, 2, and 6. The primary endpoint was a composite of in-hospital mortality and postoperative complications, including sepsis, graft occlusion, acute renal failure, and stroke. Logistic regression and random forest classifiers were used to model the primary outcomes.
RESULTS: Frail patients exhibited significantly higher IL-6 and CRP levels and lower IGF-1 levels than non-frail and pre-frail patients. The EuroSCORE alone had limited discriminatory power (AUC = 0.62). The predictive accuracy improved with the addition of EFS (AUC = 0.75), and the random forest model incorporating biomarkers further increased the accuracy (AUC = 0.80). Spearman’s correlations showed moderate associations between EFS and IL-6 (r = 0.43), CRP (r = 0.36), and IGF-1 (r = − 0.41).
CONCLUSIONS: Combining frailty assessment, inflammatory/nutritional biomarkers, and traditional surgical risk scoring yields a more accurate prediction of postoperative mortality and complications in patients undergoing cardiac surgery than EuroSCORE alone. Elevated IL-6 and CRP levels, together with reduced IGF-1 concentrations, are closely associated with frailty and adverse outcomes, highlighting the pivotal role of preoperative inflammatory and nutritional status in shaping recovery trajectories.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO81
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Clinician Reported Outcomes, Relating Intermediate to Long-term Outcomes
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)