衰弱对老年卒中患者的影响：卒中血管内治疗后的神经功能结局和死亡率：一项德国全国性卒中登记分析。

Frailty's influence on older stroke patients: Neurological outcome and mortality after endovascular treatment in stroke: A national German stroke registry analysis.

作者信息

Schnieder Marlena, Metz Hannah, Baehr Mathias, Alegiani Anna, Wunderlich Silke, Nolte Christian H, Reich Arno, Pinho João, Huber Christiane, Petzold Gabor, Tiedt Steffen, von Arnim Christine Af, Liman Jan

机构信息

Department of Neurology, University Medical Centre Goettingen, Göttingen, Germany.

Department of Geriatrics, University Medical Centre Goettingen, Göttingen, Germany.

出版信息

Eur Stroke J. 2025 Jun 11:23969873251344202. doi: 10.1177/23969873251344202.

DOI:10.1177/23969873251344202

PMID:40497328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12158978/

Abstract

INTRODUCTION

Frailty is a clinical syndrome particular in old patients with an increased risk of adverse health-care events. In geriatric stroke patients who received endovascular treatment, monocentric analyses have demonstrated that frailty affects mortality and functional outcome. We aimed to investigate the impact of frailty in a larger multicentric cohort.

PATIENTS AND METHODS

We analyzed the impact of frailty on outcome in patients with stroke who underwent endovascular treatment in seven academic centers contributing to the German Stroke Registry. We calculated the Hospital Frailty Risk Score (HFRS) for all patients aged ⩾ 65 years. Functional outcome was measured by modified Rankin Scale (mRS) 3 months after the stroke event. A regression analysis conducted to assess mortality and functional outcome, adjusted for factors known to influence outcomes.

RESULTS

2468 patients fulfilled the inclusion criteria. Median HFRS was 1.1 (IQR 0-2.95) and 449 (18.2%) patients had HFRS > 5. Low, intermediate and high-frailty risk was present in 2009 (71.7%), 389 (15.8%), and 60 (2.44%) respectively. A favorable neurological outcome (mRS 0-2) was achieved in 31.7%, 20.6%, and 13.8% in the low-, moderate, and high-risk-frailty-groups respectively ( < 0.001). Multivariate regression analysis showed a significant associations of HFRS on both mortality (adjusted OR 1.033, 95% CI: 1.004-1.063, = 0.024) and functional outcome (adjusted OR: 0.962, 95% CI: 0.929-0.997; = 0.033) after 3 months. However, there was no significant difference in baseline NHISS scores between frail and non-frail patients (14 (IQR 19-19)) vs 15 (IQR 11-19) vs 15 (IQR 10-19); = 0.295). Besides door-to-groin time (DTN) differed with high frailty-risk patients having the longest DTN times (64 (38-102) vs 67.5 (45-95) vs 80 (54-106); = 0.020).

DISCUSSION AND CONCLUSION

We identified frailty as a factor strongly associated with both mortality and functional outcome in ischemic stroke patients undergoing thrombectomy.

摘要

引言

衰弱是一种临床综合征，在老年患者中尤为常见，其发生不良医疗事件的风险增加。在接受血管内治疗的老年卒中患者中，单中心分析表明衰弱会影响死亡率和功能结局。我们旨在研究在更大的多中心队列中衰弱的影响。

患者与方法

我们分析了衰弱对在德国卒中登记处的7个学术中心接受血管内治疗的卒中患者结局的影响。我们计算了所有年龄≥65岁患者的医院衰弱风险评分（HFRS）。在卒中事件发生3个月后，通过改良Rankin量表（mRS）测量功能结局。进行回归分析以评估死亡率和功能结局，并对已知影响结局的因素进行调整。

结果

2468例患者符合纳入标准。HFRS中位数为1.1（四分位间距0 - 2.95），449例（18.2%）患者的HFRS>5。低、中、高衰弱风险分别存在于2009例（71.7%）、389例（15.8%）和60例（2.44%）患者中。低、中、高风险衰弱组分别有31.7%、20.6%和13.8%的患者获得了良好的神经功能结局（mRS 0 - 2）（P<0.001）。多变量回归分析显示，HFRS与3个月后的死亡率（调整后的比值比1.033，95%置信区间：1.004 - 1.063，P = 0.024）和功能结局（调整后的比值比：0.962，95%置信区间：0.929 - 0.997；P = 0.033）均显著相关。然而，衰弱和非衰弱患者的基线美国国立卫生研究院卒中量表（NHISS）评分无显著差异（14（四分位间距19 - 19）对15（四分位间距11 - 19）对15（四分位间距10 - 19）；P = 0.295）。此外，从入院到股动脉穿刺时间（DTN）有所不同，高衰弱风险患者的DTN时间最长（64（38 - 102）对67.5（45 - 95）对80（54 - 106）；P = 0.020）。