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老年患者衰弱作为血管内治疗的大血管闭塞性卒中患者预后因素的分析

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes.

作者信息

Schnieder Marlena, Bähr Mathias, Kirsch Mareike, Maier Ilko, Behme Daniel, Riedel Christian Heiner, Psychogios Marios-Nikos, Brehm Alex, Liman Jan, von Arnim Christine A F

机构信息

Department of Neurology, University Medical Center Göttingen, 37073 Göttingen, Germany.

Department of Geriatrics, University Medical Center Göttingen, 37073 Göttingen, Germany.

出版信息

J Clin Med. 2021 May 18;10(10):2171. doi: 10.3390/jcm10102171.

Abstract

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015-2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5-15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

摘要

衰弱与老年患者不良医疗结局风险增加相关。医院衰弱风险评分(HFRS)已被开发出来,并被证明能够识别出具有不良结局高风险的患者。我们旨在调查衰弱患者在经历血管内治疗的大血管闭塞性卒中(LVOS)后是否也面临不良结局。在这项回顾性观察队列研究中,我们分析了2015年至2019年期间因LVOS和血管内治疗入院的65岁及以上患者。主要结局是三个月后的死亡率和改良Rankin量表(mRS)。使用回归模型来确定衰弱的影响。该队列共纳入318例患者。HFRS的中位数为1.6(四分位间距4.8)。共有238例(75.1%)患者符合低衰弱风险标准(HFRS<5.72),22.7%为中度衰弱风险(HFRS为5至15),7例(2.2%)为高衰弱风险。多因素回归分析显示,HFRS与90天后死亡率增加相关(95%置信区间1.001至1.236;比值比1.112),且与更差的mRS相关(95%置信区间1.004至1.270;比值比1.129)。我们确定衰弱是LVOS患者接受血栓切除术时功能结局和死亡率的一个影响因素。

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