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He H, Liu M, Li L, Zheng Y, Nie Y, Xiao LD, Li Y, Tang S. The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study. Int J Nurs Stud 2024; 154:104735. [PMID: 38521005 DOI: 10.1016/j.ijnurstu.2024.104735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. OBJECTIVE To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DESIGN A multicenter prospective cohort study. SETTING Two tertiary hospitals in Central and Northwest China. PARTICIPANTS 667 adult stroke patients in stroke units were included from January 2022 to June 2022. METHODS Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. RESULTS A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. CONCLUSIONS The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. TWEETABLE ABSTRACT Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.
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Affiliation(s)
- Haiyan He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China; International Medical Centre, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueping Zheng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqin Nie
- Department of Nursing, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
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Peycheva M, Padlina G, Genceviciute K, Krasteva MP, Boronylo A, Goeldlin MB, Müller M, Wenz ES, Müller MD, Hammer H, Bücke P, Bigi S, Simonetti BG, Hoffmann A, Umarova RM, Pilgram-Pastor S, Gralla J, Mordasini P, Antonenko K, Heldner MR. Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex. Front Neurol 2024; 15:1293905. [PMID: 38694775 PMCID: PMC11061446 DOI: 10.3389/fneur.2024.1293905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Aim The aim of this study was to investigate baseline characteristics and outcome of patients after endovascular therapy (EVT) for acute large vessel occlusion (LVO) in relation to their history of symptomatic vascular disease and sex. Methods Consecutive EVT-eligible patients with LVO in the anterior circulation admitted to our stroke center between 04/2015 and 04/2020 were included in this observational cohort study. All patients were treated according to a standardized acute ischaemic stroke (AIS) protocol. Baseline characteristics and successful reperfusion, recurrent/progressive in-hospital ischaemic stroke, symptomatic in-hospital intracranial hemorrhage, death at discharge and at 3 months, and functional outcome at 3 months were analyzed according to previous symptomatic vascular disease and sex. Results 995 patients with LVO in the anterior circulation (49.4% women, median age 76 years, median admission NIHSS score 14) were included. Patients with multiple vs. no previous vascular events showed higher mortality at discharge (20% vs. 9.3%, age/sex - adjustedOR = 1.43, p = 0.030) and less independency at 3 months (28.8% vs. 48.8%, age/sex - adjustedOR = 0.72, p = 0.020). All patients and men alone with one or multiple vs. patients and men with no previous vascular events showed more recurrent/progressive in-hospital ischaemic strokes (19.9% vs. 6.4% in all patients, age/sex - adjustedOR = 1.76, p = 0.028) (16.7% vs. 5.8% in men, age-adjustedOR = 2.20, p = 0.035). Men vs. women showed more in-hospital symptomatic intracranial hemorrhage among patients with one or multiple vs. no previous vascular events (23.7% vs. 6.6% in men and 15.4% vs. 5.5% in women, OR = 2.32, p = 0.035/age - adjustedOR = 2.36, p = 0.035). Conclusions Previous vascular events increased the risk of in-hospital complications and poorer outcome in the analyzed patients with EVT-eligible LVO-AIS. Our findings may support risk assessment in these stroke patients and could contribute to the design of future studies.
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Affiliation(s)
- Marieta Peycheva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology and Research Institute, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Giovanna Padlina
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Clinica Luganese, Mancucco, Lugano, Switzerland
| | - Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marina P. Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Queen Giovanna, Sofia, Bulgaria
| | - Anna Boronylo
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Madlaine Müller
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Elena S. Wenz
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Paediatric Neurology, Department of Paediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Barbara Goeggel Simonetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Neuropaediatrics, Istituto Pediatrico della Svizzera Italiana IPSI EOC, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Angelika Hoffmann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Roza M. Umarova
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Netzwerk Radiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Cai H, Zhang H, Liang J, Liu Z, Huang G. Genetic liability to frailty in relation to functional outcome after ischemic stroke. Int J Stroke 2024; 19:50-57. [PMID: 37542426 DOI: 10.1177/17474930231194676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
BACKGROUND Frailty appears to be associated with unfavorable prognosis after stroke in observational studies, but the causality remains largely unknown. AIMS The aim of this study is to investigate the potential causal effect of frailty on functional outcome at 3 months after ischemic stroke using the Mendelian randomization (MR) framework. METHODS Genetic instruments for frailty index were identified in a genome-wide association study meta-analysis including 175,226 individuals of European descent. Corresponding genetic association estimates for functional outcome after ischemic stroke at 90 days were taken from the Genetic of Ischemic Stroke Functional Outcome (GISCOME) network of 6021 patients. We performed inverse-variance weighted MR as the main analyses, followed by several alternate methods and sensitivity analyses. RESULTS In univariable MR, we found evidence that genetically predicted higher frailty index (odds ratio (OR) = 5.12; 95% confidence interval (CI) = 1.31-20.09; p = 0.019) was associated with worse functional outcome (modified Rankin Scale score ⩾3) after ischemic stroke. In further multivariable MR adjusting for potential confounding traits including body mass index, C-reactive protein, inflammatory bowel disease, and smoking initiation, the overall patterns between genetic liability to frailty and poor functional outcome status remained. Sensitivity analyses with complementary methods and with model unadjusted for baseline stroke severity (OR = 4.19; 95% CI = 1.26-13.90; p = 0.019) yielded broadly concordant results. CONCLUSIONS The present MR study suggested a possible causal effect of frailty on poor functional outcome after ischemic stroke. Frailty might represent a potential target for intervention to improve recovery after ischemic stroke.
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Affiliation(s)
- Huan Cai
- Department of Rehabilitation Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Hao Zhang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jialin Liang
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, Zhongshan, China
| | - Zhonghua Liu
- Department of Rehabilitation Medicine, Zhongshan City People's Hospital, Zhongshan, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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Bao Q, Huang X, Wu X, Chen S, Yang J, Zhang J, Li J, Yang M. Implications of frailty in acute ischemic stroke receiving endovascular treatment: systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:969-978. [PMID: 36964867 DOI: 10.1007/s40520-023-02383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Frailty is a state of cumulative degeneration of bodily functions that is consistently associated with poor outcomes in older people following illness. Combined stroke intervention and frailty may yield additive and synergistic effects adults with stroke. OBJECTIVE To evaluate the safety and efficacy of endovascular therapy (EVT) in frail patients. METHODS We conducted a systematic review of the relationship between debilitation and acute ischemic stroke (AIS) after EVT. Until August 2022, researchers have searched three databases (Pubmed, EMBASE and Cochrane). Random-effects meta-analysis, combined ratio (OR) and 95% confidence interval (95%CI) were used to assess efficacy values. The I2 statistic was used to assess heterogeneity. Comprehensive meta-analysis software was used for meta-analysis. RESULTS We ultimately included eight studies including 3662 non-overlapping participants. Four studies used the Clinical Frailty Scale (CFS), two studies used the Hospital Frailty Risk Score (HFRS), a study used frailty index and a study used the comprehensive geriatric assessment (CGA). Frailty prevalence: 35%; 95% CI, 0.27-0.43; low quality evidence, downgraded due to heterogeneity, bias. Random effects showed that poor functional outcome (5 studies, OR 1.956, 95% CI 1.256-3.048) and mortality (9 studies, OR 2.320, 95% CI 1.680-3.205) was significantly associated with frailty. In adjusted analyses, poor functional outcome (4 studies, ORadj 1.189, 95% CI 1.043-1.357), and mortality (3 studies, ORadj 1.036, 95% CI 1.008-1.065) were significantly associated with frailty. CONCLUSION Pre-stroke frailty is an important predictor of poor prognosis assessed by EVT and can be added to the classical predictors of stroke outcome. Routine assessment of pre-stroke frailty can help patients to make decisions about the efficacy of their choice of EVT.
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Affiliation(s)
- QiangJi Bao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - XiaoDong Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - XinTing Wu
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - ShuJun Chen
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - JinCai Yang
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - JingNi Zhang
- Department of Science and Education, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
| | - Jing Li
- Department of Community Health Education, Institute for Health Education of Qinghai Province, Xining, 810000, Qinghai, China.
| | - MingFei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai, China.
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Huang YN, Yan FH, Wang XY, Chen XL, Chong HY, Su WL, Chen YR, Han L, Ma YX. Prevalence and Risk Factors of Frailty in Stroke Patients: A Meta-Analysis and Systematic Review. J Nutr Health Aging 2023; 27:96-102. [PMID: 36806864 DOI: 10.1007/s12603-023-1879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Summarize the existing evidence regarding the prevalence and risk factors of frailty in stroke patients. DESIGN A meta-analysis and systematic review. PARTICIPANTS Stroke patients in hospitals or communities. METHODS We undertook a systematic review and meta-analysis using articles available in 8 databases, including PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Weipu Database (VIP) from January 1990 to April 2022. Studies were quality rated using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality tool. RESULTS A total of 24 studies involving 30,423 participants were identified. The prevalence of frailty and pre-frailty in stroke patients was 27% (95%CI: 0.23-0.31) and 47.9% (95%CI: 0.43-0.53). Female gender (OR = 1.76, 95%CI: 1.63-1.91), advanced age (MD = 6.73, 95%CI: 3.55-9.91), diabetes (OR = 1.34, 95%CI: 1.06-1.69), hyperlipidemia (OR = 1.46, 95%CI: 1.04-2.04), atrial fibrillation (OR = 1.36, 95%CI: 1.01-1.82), National Institutes of Stroke Scale (NIHSS) admission scores (MD = 2.27, 95%CI: 1.72-2.81) were risk factors of frailty in stroke patients. CONCLUSIONS Frailty was more prevalent in stroke patients. Female gender, advanced age, diabetes, hyperlipidemia, atrial fibrillation, and National Institutes of Stroke Scale (NIHSS) admission scores were identified as risk factors for frailty in stroke patients. In the future, medical staff should pay attention to the early screening of frailty in high-risk groups and provide information on its prevention.
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Affiliation(s)
- Y N Huang
- Yuxia Ma, Lin Han, Lanzhou University, China ,
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Casetta I, Fainardi E, Pracucci G, Saia V, Sallustio F, da Ros V, Nappini S, Nencini P, Bigliardi G, Vinci S, Grillo F, Bracco S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Simonetti L, Zini A, Ruggiero M, Longoni M, Castellan L, Malfatto L, Castellini P, Cosottini M, Comai A, Franchini E, Lozupone E, Della Marca G, Puglielli E, Casalena A, Baracchini C, Savio D, Duc E, Ricciardi G, Cappellari M, Chiumarulo L, Petruzzellis M, Cavallini A, Cavasin N, Critelli A, Burdi N, Boero G, Giorgianni A, Versino M, Biraschi F, Nicolini E, Comelli S, Melis M, Padolecchia R, Tassinari T, Paolo Nuzzi N, Marcheselli S, Sacco S, Invernizzi P, Gallesio I, Ferrandi D, Fancello M, Valeria Saddi M, Russo M, Pischedda A, Baule A, Mannino M, Florio F, Inchingolo V, Elena Flacco M, Romano D, Silvagni U, Inzitari D, Mangiafico S, Toni D. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study. Eur Stroke J 2022; 7:151-157. [PMID: 35647312 PMCID: PMC9134778 DOI: 10.1177/23969873221091648] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND AND PURPOSE We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients. METHODS From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set. RESULTS Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53). CONCLUSIONS Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.
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Affiliation(s)
- Ilaria Casetta
- Clinical Neurology, University of
Ferrara, Ferrara, Italy
| | | | | | - Valentina Saia
- Hospital Santa Corona Pietra Ligure,
Pietra Ligure, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Andrea Saletti
- Azienda Ospedaliero Universitaria di
Ferrara, Ferrara, Italy
| | | | | | - Mauro Magoni
- Azienda Socio Sanitaria Territoriale
degli Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Zini
- IRCCS Istituto Delle Scienze
Neurologiche di Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrica Duc
- Ospedale San Giovanni Bosco, Torino,
Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesco Florio
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Inchingolo
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | - Danilo Toni
- University of Rome La Sapienza, RM,
Roma, Italy
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