O-051 - EVALUATION OF THE PROGNOSTIC VALUE OF THE INFLAMMATION-BASED MODIFIED GLASGOW PROGNOSTIC SCORE IN PATIENTS UNDER EVAR AND F/B-EVAR

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Bradley N. (Clinical Research Fellow, University of Glasgow ~ Glasgow ~ United Kingdom) , Roxburgh C. (Senior Clinical Lecturer, University of Glasgow ~ Glasgow ~ United Kingdom) , Mcmillan D. (Professor of Surgical Sciences, University of Glasgow ~ Glasgow ~ United Kingdom) , Guthrie G. (Honorary Clinical Senior Lecturer, University of Glasgow ~ Glasgow ~ United Kingdom)
Introduction:
EVAR has become the predominant method of repair of AAA, with approximately 65% of AAA in the UK undergoing EVAR[1], and F/B-EVAR increasingly being used for juxta- / supra-renal aneurysms. Pre-operative markers of the systemic inflammatory response (SIR) predict mortality in patients undergoing EVAR[2], [3], and chronic activation of the SIR is associated with increased cardiovascular morbidity and mortality[4]. The modified Glasgow Prognostic Score (mGPS) is a prognostic scoring system incorporating markers of systemic inflammation (C-reactive protein (CRP) and albumin), first described in patients with cancer[5], [6]. mGPS has subsequently been found to provide prognostic value in non-cancer populations[7], however has not been reported in patients with AAA. This study aims to describe the prognostic value of mGPS in a cohort of patients undergoing EVAR and F/B-EVAR.
Methods:
This single centre study retrospectively identified 259 consecutive patients who underwent emergency or elective EVAR and F/B-EVAR between 01/01/2015 and 01/01/2021. Patients without pre-operative CRP or albumin were excluded. The method of mGPS calculation is shown in table 1. Comparisons between subgroups of mGPS were performed. p < 0.05 was considered significant. Statistical analyses were performed using IBM SPSS v28.0.
Results:
164 patients with calculable pre-operative mGPS score were included, with a median follow-up of 55.0 months and over 12.0 months follow-up on all patients. 14.0% were emergency cases, and 66.5% underwent standard EVAR. There were 115 patients (70.1%) with mGPS = 0, 27 patients (16.5%) with mGPS = 1, and 22 patients (13.4%) with mGPS = 2. Mean (95% CI) survival in the mGPS 0 / 1 / 2 subgroups was 68.0 (63.5 - 72.5) vs. 50.9 (39.5 - 62.2) vs. 45.7 (31.6 - 59.9) months (p = 0.001, figure 1). Elevated mGPS was associated with emergency procedure (OR 7.89, 95% CI 3.95 - 15.75, p < 0.001) and 30-day mortality (OR 3.86, 95% CI 1.42 - 10.50, p < 0.01). In all patients, elevated mGPS was associated with inferior survival (HR 1.82, 95% CI 1.29 - 2.57, p < 0.001). In elective patients only, there was a non-significant trend towards inferior survival in patients with elevated mGPS (HR 1.43, 95% CI 0.83 - 2.46, p > 0.05), and a non-significant trend towards increased 30-day mortality in patients with elevated mGPS (OR 3.51, 95% CI 0.12 - 17.19, p > 0.05). The area under the curve (AUC) for mGPS as a predictor of mortality was 0.62 (95% CI 0.52 - 0.71, p < 0.05).
Conclusion:
The present study describes the novel association between mGPS and prognosis in patients undergoing EVAR and F/B-EVAR. The association between mGPS and inferior survival is present at both early (30-day) and long-term follow-up. Increased SIR may be a contributary factor to the development of multi-organ failure following emergency intervention for AAA. In this setting the characterisation of inflammatory pathways and identification of therapeutic targets to modulate the SIR is an important area for future research. Assessment of the SIR in serial post-operative timepoints may allow for greater understanding of the post-operative course following EVAR and identification of patients at higher risk of inferior long-term outcome.
References:
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