Yang Fuxia, Li Nan, Yang Lu, Chang Jie, Yan Aijuan, Wei Wenshi
Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
Front Neurol. 2022 May 30;13:855532. doi: 10.3389/fneur.2022.855532. eCollection 2022.
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.
We investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction.
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).
Frailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% 1.35-13.67, = 0.014]. However, frailty had no independent effect on 1-year mortality ( = 1.47, 95% 0.78-2.79, = 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 (a): 8.86, 95% 3.07-25.58, < 0.001; frailty a: 7.68, 95% 2.03-29.12, = 0.002] or 1 year (pre-frailty a: 8.86, 95% 3.07-25.58, < 0.001; frailty a: 7.68, 95% 2.03-29.12, = 0.003).
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.
衰弱是一种生理功能累积退化的状态，会导致残疾或死亡等不良后果。目前，对于老年急性脑梗死患者卒中前衰弱状态的预后仍知之甚少。
我们研究了卒中前衰弱状态与急性脑梗死28天和1年生存结局以及功能恢复之间的关联。
收集了314例年龄在65 - 99岁的急性脑梗死患者的临床资料。生存队列分析中有261例患者完成随访，功能恢复队列分析中有215例患者完成随访。采用衰弱评分（FRAIL）评估卒中前衰弱状态，采用改良Rankin量表（mRS）评估预后，采用美国国立卫生研究院卒中量表（NIHSS）评估疾病严重程度。
在生存分析队列中，衰弱与28天死亡率独立相关[风险比（HR）= 4.30，95%可信区间为1.35 - 13.67，P = 0.014]。然而，衰弱对1年死亡率无独立影响（HR = 1.47，95%可信区间为0.78 - 2.79，P = 0.237），但它与高龄、脑梗死严重程度以及住院期间合并感染独立相关。在功能恢复队列中，调整潜在混杂因素后的逻辑回归分析显示，衰弱和NIHSS评分与28天（卒中前调整优势比（a）：8.86，95%可信区间为3.07 - 25.58，P < 0.001；衰弱a：7.68，95%可信区间为2.03 - 29.12，P = 0.002）或1年（卒中前a：8.86，95%可信区间为3.07 - 25.58，P < 0.001；衰弱a：7.68，95%可信区间为2.03 - 29.12，P = 0.003）时的卒中后严重残疾（mRS > 2）显著相关。
卒中前衰弱是28天死亡率以及28天或1年严重残疾的独立危险因素。年龄、NIHSS评分和合并感染同样是1年死亡率的独立危险因素。
