Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; International Medical Centre, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
Int J Nurs Stud. 2024 Jun;154:104735. doi: 10.1016/j.ijnurstu.2024.104735. Epub 2024 Mar 1.
Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients.
To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability.
A multicenter prospective cohort study.
Two tertiary hospitals in Central and Northwest China.
667 adult stroke patients in stroke units were included from January 2022 to June 2022.
Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models.
A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS.
The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke.
Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.
衰弱在中风患者中很常见，与不良预后有关。然而，在出院的成年中风患者中，关于基线衰弱与短期预后之间因果关系的纵向研究仍存在空白。
研究衰弱对非选择性再入院和主要不良心脑血管事件的因果影响，并探讨其与认知障碍和中风后残疾的关系。
多中心前瞻性队列研究。
中国中部和西北部的两家三级医院。
2022 年 1 月至 6 月期间，共有 667 名中风病房的成年中风患者入选。
采用衰弱量表评估基线衰弱。使用定制的问题评估非选择性再入院和主要不良心脑血管事件作为主要结局。在 3 个月的随访中，使用简易精神状态检查量表（MMSE）评估认知障碍，使用改良 Rankin 量表（mRS）评估中风后残疾作为次要结局。采用双变量和多 Cox 回归分析评估基线衰弱对非选择性再入院和主要不良心脑血管事件的影响。此外，通过广义线性模型研究基线衰弱与认知障碍或中风后残疾之间的关系。
在 667 名成年中风患者中，共有 5 名患者死亡，12 名患者发生主要不良心脑血管事件，57 名患者非选择性再入院。衰弱是中风患者非选择性再入院（风险比 [HR]：2.71，95%置信区间 [CI]：1.59，4.62）和主要不良心脑血管事件（HR：3.77，95%CI：1.07，13.22）的独立危险因素。基线衰弱与认知障碍相关（调整社会人口学和临床因素以及随访间隔后，回归系数 [β]：-2.68，95%CI：-3.78，-1.58）。然而，当进一步调整基线 MMSE 时，衰弱与认知障碍之间的关系没有达到统计学意义（β：-0.39，95%CI：-1.43，0.64）。此外，基线衰弱与中风后残疾相关（调整社会人口学和临床变量、随访间隔和基线 mRS 后，β：0.36，95%CI：0.08，0.65）。
研究结果强调了评估出院成年中风患者基线衰弱的重要性，因为基线衰弱与 3 个月时的非选择性再入院、主要不良心脑血管事件和中风后残疾显著相关。这些结果突出了筛查和评估衰弱状态在改善成年中风患者短期预后方面的重要作用。应制定干预措施来解决基线衰弱问题，并减轻中风的短期预后。
基线衰弱可预测成年中风患者的非选择性再入院、主要不良心脑血管事件和中风后残疾。@haiyanhexyyy。
