Preoperative Blood Pressure Complexity Indices as a Marker for Frailty in Patients Undergoing Cardiac Surgery

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Rangasamy, V (Author) Other; Henriques, TS (Author) FMUP; Xu, XL (Author) Other; Subramaniam, B (Author) Other

Journal

Title: Journal of Cardiothoracic and Vascular Anesthesia

Vol. 34

Pages: 616-621

ISSN: 1053-0770

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 1 Citation

Scopus - 4 Citations

Other information

Authenticus ID: P-00R-97H

DOI: 10.1053/j.jvca.2019.09.035

Abstract (EN): Objective: Frailty, a state of decreased physiological reserve, increases the risk of adverse outcomes. There is no standard tool for frailty during perioperative period. Autonomic dysfunction, an underlying process in frailty, could result in hemodynamic fluctuations. Complexity, the physiological adaptability of a system can quantify these fluctuations. The authors hypothesized that complexity could be a marker for frailty and explored their relationship in cardiac surgical patients. Design: Prospective, observational study. Setting: Single-center teaching hospital. Participants: Three hundred and sixty-four adult patients undergoing cardiac surgery. Intervention: None. Measurements and Main Results: Preoperative beat-to-beat systolic arterial pressure (SAP) and mean arterial pressure (MAP) time series were obtained. Complexity indices were calculated using multiscale entropy (MSE) analysis. Frailty was assessed from: age >70 years, body mass index <18.5, hematocrit <35%, albumin <3.4 g/dL, and creatinine >2.0 mg/dL. The association between complexity indices and frailty was explored by logistic regression and predictive ability by C-statistics. In total, 190 (52%) patients had frailty. The complexity index (MSED median (quartile 1, quartile 3) of SAP and MAP time series decreased significantly in frail patients (SAP: 8.32 [7.27, 9.24] v 9.13 [8.00, 9.72], p < 0.001 and MAP: 8.56 [7.56; 9.27] v 9.18 [8.26; 9.83], p < 0.001). MSE (Sigma) demonstrated a fair predictive ability of frailty (C-statistic: SAP 0.62 and MAP 0.64). Conclusion: Preoperative BP complexity indices correlate and predict frailty. Impaired autonomic control is the underlying mechanism to explain this finding. A simple automated measure of preoperative BP complexity in the surgeon's office has the potential to reliably assess frailty.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 6