Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.
Age Ageing. 2022 Mar 1;51(3). doi: 10.1093/ageing/afac064.
frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes.
paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models.
we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2-33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9-83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41-5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies).
despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.
衰弱在老年人中很常见，与疾病后预后不良有关。尽管中风主要是老年人的疾病，但我们对中风患者衰弱的了解有限。我们旨在整理有关急性中风和衰弱的文献，以评估中风前衰弱的患病率及其与结局的关系。
配对研究人员搜索多学科电子数据库，以查找描述衰弱和急性中风的论文。我们使用适合研究设计的纽卡斯尔-渥太华工具评估偏倚风险。我们使用随机效应模型对中风前衰弱的汇总估计值进行评估。我们整理了研究报告在调整模型中，衰弱与临床结局之间是否存在显著正相关。
我们纳入了 14 项研究（n=27210 名参与者）。7 项研究（n=8840 名）使用衰弱指数方法，4 项研究（n=14924 名）使用医院衰弱风险评分。中风前衰弱的总体患病率为 24.6%（95%置信区间：16.2-33.1%；低质量证据，因异质性和偏倚而降级）。合并衰弱和衰弱前期（9 项研究，n=23827），任何衰弱综合征的患病率为 66.8%（95%置信区间：49.9-83.7%）。7 项研究存在参与者选择或衰弱评估方法的偏倚风险。中风前衰弱与所有评估的不良结局相关，包括长期死亡率（6 项报告该结局的研究中有 6 项存在阳性关联；优势比：3.75 [95%置信区间：2.41-5.70]）、住院时间（4 项研究中的 3 项）和残疾（6 项研究中的 4 项）。
无论采用何种方法测量，衰弱在急性中风患者中很常见，与不良结局相关。这对中风服务和路径的设计具有影响。
