Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study

Abstract

BackgroundFrailty 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.ObjectiveWe investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction.MethodsClinical 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).ResultsFrailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 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 (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003).ConclusionsPre-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.

Morphology of paraspinal muscles in frail and non-frail older adults evaluated through FRAIL scale

“…Frailty is a condition characterized by the progressive deterioration of physiological functioning, which is closely related to adverse events such as falls, decreasing mobility, hindrances in the activities of daily life, hospitalization, and deaths [24]. Frailty leads to physical deterioration and reduced mobility.…”

“…The FRAIL scale was published by Morley et al and used to assess frailty, which has been demonstrated as an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as a decline in health functioning and mortality [14,24]. Although MRI is more accurate in assessing paraspinal muscle mass, it has the disadvantage of being timeconsuming, labor-intensive, and expensive.…”

Association between pre-stroke sarcopenia risk and stroke-associated infection in older people with acute ischemic stroke

“…Sarcopenia was estimated in 15.8% of patients with acute stroke (6). Notably, pre-stroke sarcopenia is independently associated with severe disability and high mortality rates (7,8). In addition, skeletal muscle has been considered an essential regulator of immune system function (9).…”

Evaluating the FRAIL Questionnaire as a Trigger for Palliative Care Consultation After Acute Stroke

“…They suggested that future research should focus on which patients with stroke would benefit from specialty PC. 13 Current evidence suggests that a patient's prestroke frailty status impacts outcomes after acute stroke [14][15][16][17] and may be an appropriate trigger for PCC. However, the best way to screen for frailty after acute stroke has not been well explored.…”

“…Current evidence suggests that a patient’s prestroke frailty status impacts outcomes after acute stroke 14-17 and may be an appropriate trigger for PCC. However, the best way to screen for frailty after acute stroke has not been well explored.…”