Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

Abstract

INTRODUCTION The aim of this study was to assess the value of the Hardman Index and the Glasgow Aneurysm Score in predicting postoperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA), and to assess the correlation between the two. PATIENTS AND METHODS Patients admitted with rAAA were identified from a hospital database. Hospital records were reviewed and a retrospective Hardman Index and Glasgow Aneurysm Score was calculated. Poor postoperative prognosis was considered at a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3. RESULTS A total of 96 patients with a median age of 77.5 years (interquartile range, 71-83 years) and a male:female ratio of 2:1 were identified. Of these, 37 patients were not offered surgery and this was associated with 100% mortality. Of the 59 operated patients, 36 (61%) patients died postoperatively. Operated patients had a median Glasgow Aneurysm Score of 91 (interquartile range, 77-101) and a Hardman Index of 2 (interquartile range, 1-2). In this group, a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3 was not associated with mortality (P = 0.10 and P = 0.79, respectively). Correlation between the scoring systems was poor (+0.42 τ b ). CONCLUSIONS The scoring systems assessed did not help predict the outcome of rAAA surgery, and correlated poorly with each other. They do not aid clinical judgement. GATT GOLDSMITH MARTINEZ et al.

Usefulness of the Hardman index in predicting outcome after endovascular repair of ruptured abdominal aortic aneurysms

“…2,6,[8][9][10][11][12][13]16,17 These figures confirm the significant predictive effect of the index but also its failure to consistently identify a subgroup of patients with 100% mortality in which surgery should be withheld. The authors of the meta-analysis speculated that the utility of the index seemed to be impeded by variability in scoring resulting from missing or nondiagnostic data, particularly with regards to ECG.…”

“…2,[8][9][10] Subsequent studies, however, yielded inconsistent results. 6,[11][12][13][14][15][16][17] Some found the index to be a poor predictor and failed to show a statistical association with death, 12-14 whereas others found a strong correlation. 6,12,15 Nevertheless, even in the latter case, the presence of Ն3 risk factors was not found to be associated consistently with a 100% mortality, and, therefore, a score Ն3 could not be used as an absolute limit for denial of surgery.…”

Neutrophil to lymphocyte ratio (NLR) of five predicts 30-day morbidity in ruptured abdominal aortic aneurysms (rAAA): A retrospective cohort study

“…Three such models are the Edinburgh Ruptured Aneurysm Score (ERAS), Hardman Index (HI) and Glasgow Aneurysm Score (GAS) [12e14]. However, the study by Gatt et al demonstrated that HI and GAS are poor predictors of outcome after rAAA repair and no thorough validation of ERAS in another cohort has been performed [15]. None of these scoring systems assess the inflammatory response in their analysis.…”

Prognostic scoring in ruptured abdominal aortic aneurysm: A prospective evaluation

“…17 Ten series have examined the validity of the Hardman Index; only one has been prospective. 3,8,9,13,16,[18][19][20][21][22] Initial reports and consensus was that the Hardman Index accurately predicted death after ruptured AAA. The presence of three or more variables was widely held to be fatal 8,9 ; however, more recent data have shown that the instrument 73 107 0 41 70 1 2 Cardiac dysfunction, suprarenal AAA 79 96 1 38 67 1 3 Cardiac dysfunction, chronic renal failure 83 121 3 88 91 2 4 Cardiac dysfunction 87 111 4 88 91 3 5 Cardiac dysfunction, chronic renal failure 89 120 3 57 77 2 6 Severe COPD 80 97 1 31 63 1 7 Previous disabling stroke 71 120 2 79 87 2 8 Pre-existing severe brain injury 76 100 1 31 63 2 9…”