The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients

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  • Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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OBJECTIVE

Health measures such as the Charlson Comorbidity Index (CCI) and the 11-factor modified frailty index (mFI-11) have been employed to predict general medical and surgical mortality, but their clinical utility is limited by the requirement for a large number of data points, some of which overlap or require data that may be unavailable in large datasets. A more streamlined 5-factor modified frailty index (mFI-5) was recently developed to overcome these barriers, but it has not been widely tested in neuro-oncology patient populations. The authors compared the utility of the mFI-5 to that of the CCI and the mFI-11 in predicting postoperative mortality in brain tumor patients.

METHODS

The authors retrospectively reviewed a cohort of adult patients from a single institution who underwent brain tumor surgery during the period from January 2017 to December 2018. Logistic regression models were used to quantify the associations between health measure scores and postoperative mortality after adjusting for patient age, race, ethnicity, sex, marital status, and diagnosis. Results were considered statistically significant at p values ≤ 0.05. Receiver operating characteristic (ROC) curves were used to examine the relationships between CCI, mFI-11, and mFI-5 and mortality, and DeLong’s test was used to test for significant differences between c-statistics. Spearman’s rho was used to quantify correlations between indices.

RESULTS

The study cohort included 1692 patients (mean age 55.5 years; mean CCI, mFI-11, and mFI-5 scores 2.49, 1.05, and 0.80, respectively). Each 1-point increase in mFI-11 (OR 4.19, p = 0.0043) and mFI-5 (OR 2.56, p = 0.018) scores independently predicted greater odds of 90-day postoperative mortality. Adjusted CCI, mFI-11, and mFI-5 ROC curves demonstrated c-statistics of 0.86 (CI 0.82–0.90), 0.87 (CI 0.83–0.91), and 0.87 (CI 0.83–0.91), respectively, and there was no significant difference between the c-statistics of the adjusted CCI and the adjusted mFI-5 models (p = 0.089) or between the adjusted mFI-11 and the adjusted mFI-5 models (p = 0.82). The 3 indices were well correlated (p < 0.01).

CONCLUSIONS

The adjusted mFI-5 model predicts 90-day postoperative mortality among brain tumor patients as well as our adjusted CCI and adjusted mFI-11 models. The simplified mFI-5 may be easily integrated into clinical workflows to predict brain tumor surgery outcomes in real time.

ABBREVIATIONS AUC = area under the ROC curve; CCI = Charlson Comorbidity Index; EHR = electronic health record; KPS = Karnofsky Performance Status; mFI-5 = 5-factor modified frailty index; mFI-11 = 11-factor modified frailty index; NSQIP = National Surgical Quality Improvement Program; ROC = receiver operating characteristic; sICH = spontaneous intracerebral hemorrhage.

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Contributor Notes

Correspondence Debraj Mukherjee: Johns Hopkins University School of Medicine, Baltimore, MD. dmukher1@jhmi.edu.

INCLUDE WHEN CITING Published online August 14, 2020; DOI: 10.3171/2020.5.JNS20766.

Disclosures Dr. Brem reports being a consultant for AsclepiX Therapeutics, StemGen, InSightec, Accelerating Combination Therapies, Camden Partners, LikeMinds, Inc., Galen Robotics, Inc., NexImmune, and Nurami Medical and receiving support of non–study-related clinical or research effort overseen by the author from Arbor Pharmaceuticals, Bristol-Myers Squibb, and Acuity Bio Corp.

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