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

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-06-11 DOI:10.1177/23969873251344202

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

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引用次数: 0

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 (p < 0.001). Multivariate regression analysis showed a significant associations of HFRS on both mortality (adjusted OR 1.033, 95% CI: 1.004-1.063, p = 0.024) and functional outcome (adjusted OR: 0.962, 95% CI: 0.929-0.997; p = 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); p = 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); p = 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.

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衰弱对老年脑卒中患者的影响：脑卒中血管内治疗后的神经预后和死亡率：一项德国全国脑卒中登记分析。

简介：虚弱是一种临床综合征，特别是在老年患者中，其不良卫生保健事件的风险增加。在接受血管内治疗的老年脑卒中患者中，单中心分析表明虚弱会影响死亡率和功能预后。我们的目的是在一个更大的多中心队列中调查虚弱的影响。患者和方法：我们分析了在七个学术中心接受血管内治疗的卒中患者虚弱对预后的影响，这些中心为德国卒中登记处做出了贡献。我们为所有年龄大于或等于65岁的患者计算了医院虚弱风险评分（HFRS）。卒中后3个月用改良Rankin量表（mRS）测量功能结局。为评估死亡率和功能结果而进行的回归分析，对已知影响结果的因素进行了调整。结果：2468例患者符合纳入标准。HFRS的中位数为1.1 (IQR 0-2.95)， 449例（18.2%）患者为HFRS bb5。2009年分别有低、中、高脆弱风险（71.7%）、389例（15.8%）和60例（2.44%）。在低、中、高风险脆弱组中，分别有31.7%、20.6%和13.8%的患者获得了良好的神经预后（mRS 0-2）（p = 0.024）和功能预后(校正OR: 0.962, 95% CI: 0.929-0.997；P = 0.033)。然而，体弱和非体弱患者的基线niss评分没有显著差异(14 (IQR 19-19) vs 15 (IQR 11-19) vs 15 (IQR 10-19)；p = 0.295)。此外，门到腹股沟时间（DTN）不同于高脆弱风险患者，DTN时间最长(64 (38-102)vs 67.5 (45-95) vs 80 (54-106)；p = 0.020)。讨论和结论：我们发现，在接受血栓切除术的缺血性卒中患者中，虚弱是与死亡率和功能预后密切相关的一个因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.