Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Baptist Health South Florida, Miami, FL 33176, USA; Universidad Espíritu Santo, Samborondón, Ecuador.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):108016. doi: 10.1016/j.jstrokecerebrovasdis.2024.108016. Epub 2024 Sep 17.
Although assessment of frailty is increasingly being included in routine practice, its effects on hospital outcomes is not well studied. In this study, we used a national database to estimate the effects of frailty on hospital outcomes among stroke patients.
This study was a retrospective analysis of data from Nationwide Inpatient Sample (NIS) database collected during the years 2016 to 2019. Adult patients 45 years and older with a primary diagnosis of stroke were included for the analysis. Primary outcome was frequency of frailty among stroke patients. Secondary outcomes were in-hospital mortality, prolonged length of stay, mechanical ventilation, and acute renal failure. Frailty levels were assessed by using the Hospital Frailty Risk Score (HFRS).
Among 2,031,085 stroke hospitalizations, 362,140 (17.8 %) were non-frail, 1,333,000 (65.6 %) were pre-frail, and 335,945 (16.6 %) were frail. Regression analysis showed that the odds of mortality were significantly higher among frail (aOR, 2.82, 95 % CI: 2.63-3.04) and pre-frail (aOR, 1.62, 95 % CI: 1.53-1.73) patients, compared to non-frail patients. Similarly, the odds of mechanical ventilation were significantly higher among frail (aOR, 9.72, 95 % CI: 8.84-10.69) and pre-frail (aOR, 3.41, 95 % CI: 3.12-3.73) patients. The odds of acute renal failure were significantly higher among frail (aOR, 6.96, 95 % CI: 6.62-7.33) and pre-frail (aOR, 2.94, 95 % CI: 2.80-3.08) patients.
Collaborative efforts by neurologists, neurosurgeons, and physiatrists towards identifying frailty and incorporating it in risk estimation measures could help improve management strategies, resource utilization, and optimization of patient outcomes among frail stroke patients.
尽管衰弱评估越来越多地纳入常规实践，但它对医院结局的影响尚未得到充分研究。在这项研究中，我们使用国家数据库估计衰弱对卒中患者的医院结局的影响。
这是一项对 2016 年至 2019 年全国住院患者样本（NIS）数据库中数据的回顾性分析。纳入年龄 45 岁及以上、主要诊断为卒中的成年患者进行分析。主要结局是卒中患者的衰弱频率。次要结局是院内死亡率、延长住院时间、机械通气和急性肾衰竭。使用医院衰弱风险评分（HFRS）评估衰弱程度。
在 2031085 例卒中住院患者中，362140 例（17.8%）非衰弱，1333000 例（65.6%）衰弱前期，335945 例（16.6%）衰弱。回归分析显示，与非衰弱患者相比，衰弱（aOR，2.82，95%CI：2.63-3.04）和衰弱前期（aOR，1.62，95%CI：1.53-1.73）患者的死亡率显著更高。同样，衰弱（aOR，9.72，95%CI：8.84-10.69）和衰弱前期（aOR，3.41，95%CI：3.12-3.73）患者的机械通气几率显著更高。急性肾衰竭的几率在衰弱（aOR，6.96，95%CI：6.62-7.33）和衰弱前期（aOR，2.94，95%CI：2.80-3.08）患者中显著更高。
神经病学家、神经外科医生和物理治疗师共同努力确定衰弱，并将其纳入风险评估措施中，可能有助于改善管理策略、资源利用和优化衰弱卒中患者的结局。
