Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan.
Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
Arch Gerontol Geriatr. 2021 May-Jun;94:104370. doi: 10.1016/j.archger.2021.104370. Epub 2021 Feb 2.
The aim of this study was to investigate the effects of pre-stroke frailty status on short-term functional outcome in older patients with acute stroke.
In this prospective longitudinal study, we assessed the pre-stroke frailty status (robust, prefrail, or frail) by the Frailty Screening Index, disease severity by the National Institutes of Stroke Scale (NIHSS), and short-term functional outcome by the modified Rankin Scale (mRS) at discharge from acute hospital in patients with older stroke. We considered poor functional outcome to be a mRS >2. Logistic regression analysis and mediation analysis were used to investigate the relationships among pre-stroke frailty status, disease severity, length of stay (LOS), and short-term functional outcome.
A total of 232 patients were enrolled in this study. The NIHSS and LOS were significantly different between groups (p<0.001, p = 0.01, respectively), but there was no relationship between frailty status and short-term functional outcome (p = 0.22). Based on the logistic regression analyses after adjusting for potential confounders, the NIHSS (odds ratio (OR): 1.75, 95% confidence interval (CI): 1.44-2.14, p<0.001) and LOS (OR: 1.07, 95%CI: 1.03-1.11) were independently associated with a poor functional outcome. In the mediation analysis, the NIHSS (β=0.137, p<0.001) and LOS (β=0.09, p<0.004) were significant mediators between pre-stroke frailty status and poor functional outcome.
The relationship between pre-stroke frailty status and short-term functional outcome was mediated by disease severity and LOS in older patients with acute stroke.
本研究旨在探讨卒中前虚弱状态对老年急性脑卒中患者短期功能结局的影响。
在这项前瞻性纵向研究中，我们使用衰弱筛查指数（Frailty Screening Index）评估卒中前的虚弱状态（强壮、虚弱前期或虚弱），使用国立卫生研究院卒中量表（National Institutes of Stroke Scale，NIHSS）评估疾病严重程度，使用改良 Rankin 量表（modified Rankin Scale，mRS）评估出院时的短期功能结局。我们将 mRS＞2 定义为不良功能结局。使用逻辑回归分析和中介分析来探讨卒中前虚弱状态、疾病严重程度、住院时间（length of stay，LOS）与短期功能结局之间的关系。
本研究共纳入 232 例患者。NIHSS 和 LOS 在各组间差异有统计学意义（p<0.001，p=0.01），但虚弱状态与短期功能结局之间无相关性（p=0.22）。在调整了潜在混杂因素后，基于逻辑回归分析，NIHSS（比值比（odds ratio，OR）：1.75，95%置信区间（confidence interval，CI）：1.44-2.14，p<0.001）和 LOS（OR：1.07，95%CI：1.03-1.11）与不良功能结局独立相关。在中介分析中，NIHSS（β=0.137，p<0.001）和 LOS（β=0.09，p<0.004）是卒中前虚弱状态与不良功能结局之间的显著中介因素。
在老年急性脑卒中患者中，卒中前虚弱状态与短期功能结局的关系由疾病严重程度和 LOS 介导。
