Quit making excuses for not getting stroke patients 100% recovered. My directors never allowed excuses even for the hardest problems given to me to solve. Some of my programming problems took months to solve. I wasn't allowed to give up like this research does.
Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
Background: Frailty is a state of cumulative degradation of physiological functions that leads to adverse outcomes such as disability or mortality. Currently, there is still little understanding of the prognosis of pre-stroke frailty status with acute cerebral infarction in the elderly.
Objective: We investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction.
Methods: Clinical data were collected from 314 patients with acute cerebral infarction aged 65–99 years. A total of 261 patients completed follow-up in the survival cohort analysis and 215 patients in the functional recovery cohort analysis. Pre-stroke frailty status was assessed using the FRAIL score, the prognosis was assessed using the modified Rankin Scale (mRS), and disease severity using the National Institutes of Health Stroke Scale (NIHSS).
Results: Frailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 0.237), but it was independently associated with advanced age, the severity of cerebral infarction, and combined infection during hospitalization. Logistic regression analysis after adjusting for potential confounders in the functional recovery cohort revealed frailty, and the NIHSS score was significantly associated with post-stroke severe disability (mRS > 2) at 28 days [pre-frailty adjusted odds ratio (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003).
Conclusions: Pre-stroke frailty is an independent risk factor for 28-day mortality and 28-day or 1-year severe disability. Age, the NIHSS score, and co-infection are likewise independent risk factors for 1-year mortality.
Introduction
Stroke has become the second largest cause of death and the third largest cause of disability after ischemic heart disease and is an important factor in disability-adjusted life-years (DALYs) lost in people over 50 years old (1). In China, the prevalence of stroke exceeds that of ischemic heart disease, with more than 2 million new cases per year, making stroke the most DALYs lost among all diseases (2). Although measures such as endovascular intervention and the establishment of stroke centers have significantly reduced the mortality of the cerebrovascular disease, surviving patients have also increased the social disability burden (3). Functional recovery tended to stabilize at 3–6 months after stroke, but the recovery of different patients still showed individual differences, and some patients had accelerated accumulation of disabilities over time (4–6).
Frailty status is a meaningful manifestation of aging in the population, characterized by a decline in function across multiple physiological systems. This decline is a disproportionate change in health status caused by small stress events accompanied by an increased vulnerability to stressors (7). Frailty is more prone to negative outcomes and is a predictor of all-cause mortality (8, 9). Acute cerebral infarction produces a major impact on the body and makes patients more prone to adverse events, such as poststroke pneumonia (10), persistent disability (11), and neurocognitive disorders (12).
Shanghai, the country's most populous city, has 3,824,400 registered residents aged 65 years and above in 2020, nearly 25.9% of the population (13). There are 40 large-scale general hospitals in Shanghai. A cross-sectional study based on Fried's frailty phenotype was used to assess frailty status was performed in 780 Shanghai suburban older adults aged 65–74 years in 2019. The percentages of robust, pre-frail, and frail were 48.46, 47.69, and 3.85% (14).
This study aimed to establish the relationship between pre-stroke frailty and outcomes after acute ischemic stroke. We divided participants into survival and functional recovery cohorts and explored 28-day and 1-year post-stroke outcomes.
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