Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

Abstract

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015–2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5–15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis

“…There was considerable heterogeneity across the included studies in the tool used to assess frailty and how this was defined and classified ( Table 3 ). Seven studies used an approach based on frailty index (varying number of items included, range: 4–33; [ 14–17 , 20 , 24 , 25 ]) four studies used the Hospital Frailty Risk Score [ 19 , 22 , 23 , 28 ], albeit with differing terminology for the included categories; two used the Fried phenotype approach [ 25 , 27 ], one used pre-stroke mRS [ 21 ] and one study used the Clinical Frailty Scale (CFS; [ 13 ]). One study compared two measures of frailty in the same cohort, a 33-item frailty index and the Fried frailty phenotype, although there was substantial missing phenotype data [ 25 ].…”

“…Mortality: seven studies examined the association between frailty status and mortality risk over a range of follow-up periods [ 13 , 15 , 16 , 20 , 21 , 23 , 28 ]. Two studies specifically considered in-hospital mortality and found no association with frailty, using a frailty index and the HFRS [ 20 , 23 ].…”

“…Mortality: seven studies examined the association between frailty status and mortality risk over a range of follow-up periods [ 13 , 15 , 16 , 20 , 21 , 23 , 28 ]. Two studies specifically considered in-hospital mortality and found no association with frailty, using a frailty index and the HFRS [ 20 , 23 ]. Another reported on mortality at 28 days and found those who were frail had a higher rate of mortality and that increasing frailty remained independently associated with mortality after adjustment for cardiovascular risk factors and stroke severity, using CFS [ 13 ].…”

“…Another reported on mortality at 28 days and found those who were frail had a higher rate of mortality and that increasing frailty remained independently associated with mortality after adjustment for cardiovascular risk factors and stroke severity, using CFS [ 13 ]. Mortality at 90 days was higher in those who were frail compared to the non-frail participants in two studies, using frailty index and HFRS respectively [ 16 , 23 ]. Mortality at 180 days was higher in a single study using HFRS [ 28 ].…”

“…The study, which used mRS as a measure of frailty reported that mortality increased as mRS increased [ 21 ]. For seven papers [ 13 , 15 , 16 , 19 , 21 , 23 , 26 ], data were suitable to allow a summary analysis, the estimate of association between frailty and mortality was OR: 3.71 (95%CI: 2.41–5.70).…”