Norton score ‘reliable marker’ of frailty, predicts mortality after surgical AVR
Click Here to Manage Email Alerts
Norton score upon admission is a marker of short‐ and long‐term mortality and should be considered as a risk stratification tool for adults who are candidates for surgical aortic valve replacement, researchers reported.
The Norton scoring system includes five domains that concern fundamental aspects of well-being: physical condition, mental state, activity, mobility and continence. Data have shown that low Norton scores on admission are associated with complications and in‐hospital mortality in patients, Elion Ram, MD, a cardiac surgery resident at the Leviev Cardiothoracic and Vascular Center of Sheba Medical Center in Tel Aviv, Israel, and colleagues wrote in the study background.
“Most tools used to measure frailty focus on one or more of the five core domains that define the frailty phenotype: slowness, weakness, low physical activity, exhaustion and shrinking,” Ram and colleagues wrote. “Most of these phenotypes are difficult to measure. On the other hand, Norton scale scores are simple to measure and, accordingly, can be used as a screening assessment tool by nurses and physicians. Furthermore, the Norton scoring system is not time‐consuming.”
In a retrospective, observational study, Ram and colleagues analyzed data from 1,469 adults who underwent a first isolated aortic valve replacement surgery from 2004 to 2020. Within the cohort, 42% had a low Norton score (< 18) and 58% had a high Norton score ( 18). The mean age of patients was 68 years and 56% were men; 71% had hypertension and 63% had hyperlipidemia. Most patients (85%) had aortic valve stenosis.
The findings were published in the Journal of Cardiac Surgery.
Researchers observed higher in‐hospital mortality among frailer patients with a low Norton score compared with a high Norton score (5.5% vs. 0.8%; P < .001). The Norton score was higher among patients who survived compared with those who died after surgical AVR (17.5 vs. 11.5; P < .001).
Using logistic regression, researchers found that a low Norton score was associated with a threefold increased risk for in‐hospital mortality (OR = 3.03; P = .034). In analyses using the Norton score as a continuous measure, researchers found that each one‐point decrement in the Norton score was independently associated with a 28% increased risk for in‐hospital mortality (OR = 1.28; 95% CI, 1.14-1.43; P = .001).
“Notably, separation in event rates was more pronounced immediately after surgery and continued thereafter, suggesting that the Norton score is a reliable marker identifying a high‐risk population prone to adverse events,” the researchers wrote. “The reliability of the Norton score as a prognostic marker was maintained when used as a continuous measure, with each one-point decrement in the scale corresponding to a significant 28% increase in‐hospital mortality risk and a 16% increase at 10 years.”
Additionally, the Norton score was an independent predictor of mortality after adjustments for other risk factors, with the added value of identifying patients at high risk, the researchers noted.
“This report lays the foundation for future studies regarding preoperative rehabilitation intervention for older and frail patients who are selected to undergo elective cardiac procedures, to improve their physical performance before surgery,” the researchers wrote.
Collapse
Click Here to Manage Email Alerts