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The modified 5-item frailty index as a predictor of complications in burn patients
Doha Obed1, Samuel Knoedler2, Mustafa Salim3
1Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
Abstract:
The modified 5-item frailty index (mFI-5), as a measure of frailty and biological age, has been shown to be a reliable predictor of complications and mortality in a variety of surgical specialties. However, its role in burn care remains to be fully elucidated. We, therefore, correlated frailty with in-hospital mortality and complications after burn injury. The medical charts of all burn patients admitted between 2007 and 2020 who had ≥ 10 % of their total body surface area affected were retrospectively reviewed. Data on clinical, demographic, and outcome parameters were collected and evaluated, and mFI-5 was calculated on the basis of the data obtained. Univariate and multivariate regression analyses were used to investigate the association between mFI-5 and medical complications and in-hospital mortality. A total of 617 burn patients were included in this study. Increasing mFI-5 scores were significantly associated with increased in-hospital mortality (p < 0.0001), myocardial infarction (p = 0.03), sepsis (p = 0.005), urinary tract infections (p = 0.006), and perioperative blood transfusions (p = 0.0004). They were also associated with an increase in the length of hospital stay and the number of surgical procedures, albeit without statistical significance. An mFI-5 score of ≥ 2 was a significant predictor of sepsis (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.03 to 3.95; p = 0.04), urinary tract infection (OR = 2.82; 95% CI: 1.47 to 5.19; p = 0.002), and perioperative blood transfusions (OR = 2.61; 95% CI: 1.61 to 4.25; p = 0.0001). Multivariate logistic regression analysis revealed that an mFI-5 score of ≥ 2 was not an independent risk factor for in-hospital mortality (OR = 1.44; 95% CI: 0.61 to 3.37; p = 0.40). mFI-5 is a significant risk factor for only a few select complications in the burn population. It is not a reliable predictor of in-hospital mortality. Therefore, its utility as a risk stratification tool in the burn unit may be limited.
Insights
The modified 5-item frailty index (mFI-5) predicts certain complications like sepsis and UTIs in burn patients, but it is not a reliable predictor of in-hospital mortality. Its use in burn care risk stratification may be limited.
Area of Science:
- Burn Care
- Geriatric Medicine
- Surgical Outcomes
Background:
- The modified 5-item frailty index (mFI-5) is a validated measure of frailty and biological age.
- Its predictive value for complications and mortality is established in various surgical fields.
- The role of mFI-5 in burn injury outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between the modified 5-item frailty index (mFI-5) and in-hospital mortality.
- To determine the correlation between mFI-5 and the occurrence of medical complications in burn patients.
- To evaluate the utility of mFI-5 as a risk stratification tool in burn care.
Main Methods:
- Retrospective review of medical charts for burn patients with ≥10% total body surface area affected (2007-2020).
- Calculation of mFI-5 based on collected clinical, demographic, and outcome data.
- Univariate and multivariate regression analyses to assess the association between mFI-5 and outcomes.
Main Results:
- Increasing mFI-5 scores correlated with higher in-hospital mortality (p < 0.0001), myocardial infarction, sepsis, urinary tract infections, and need for blood transfusions.
- An mFI-5 score of ≥2 significantly predicted sepsis, urinary tract infections, and perioperative blood transfusions.
- Multivariate analysis indicated mFI-5 (≥2) was not an independent risk factor for in-hospital mortality (p=0.40).
Conclusions:
- The modified 5-item frailty index (mFI-5) is a significant risk factor for specific complications in burn patients.
- mFI-5 is not a reliable predictor of in-hospital mortality in this population.
- The utility of mFI-5 for risk stratification in burn units may be limited.
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