Andrea Pilotto1,2, Cora Brass3, Klaus Fassbender4, Fatma Merzou4, Andrea Morotti5, Niklas Kämpfer4, Antonio Siniscalchi6, Alessandro Padovani5, Piergiorgio Lochner4. 1. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.zale Spedali Civili, 1-25213, Brescia, Italy. pilottoandreae@gmail.com. 2. FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy. pilottoandreae@gmail.com. 3. Department of Neurology, Kreisklinikum Siegen, Siegen, Germany. 4. Department of Neurology, University of the Saarland, Homburg, Saar, Germany. 5. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.zale Spedali Civili, 1-25213, Brescia, Italy. 6. Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy.
Abstract
BACKGROUND: Frailty is the most important short- and long-term predictor of disability in the elderly and, thus, might influence the clinical outcome of acute treatment of stroke. OBJECTIVE: To evaluate whether frailty predicts short- and long-term all-cause mortality and neurological recovery in elderly patients who underwent reperfusion acute treatment of stroke. METHODS: The study included consecutive patients older than 65 years who underwent reperfusion treatment in a single stroke unit from 2015 to 2016. Predictors of stroke outcomes were assessed including demographics, baseline NIHSS, time to needle, treatment and medical complications. Premorbid frailty was assessed with a comprehensive geriatric assessment including functional, nutritional, cognitive, social and comorbidities status. At three and twelve months, all-cause death and clinical recovery (using modified Rankin scale, mRS) were evaluated. RESULTS: One-hundred and two patients who underwent acute reperfusion treatment for stroke entered the study (mean age 77.5, 65-94 years). Frailty was diagnosed in 32 out of 102 patients and associated with older age (p = 0.001) but no differences in baseline NIHSS score, vascular risk profile or treatment management strategy. Frailty status was associated with worse improvement at 24 h and higher in-hospital mortality. At follow-up, frail patients showed poorer survival at 3 (25% vs 3%, p = 0.008) and 12 (38% vs 7%, p = 0.001) months. Frailty was the best predictor of neurological recovery at one year follow-up (mRS 3.2 ± 1.9 vs 1.9 ± 1.9). DISCUSSION: Frailty is an important predictor of efficacy of acute treatment of stroke beyond classical predictors of stroke outcomes. Larger longitudinal studies are, thus, warranted to evaluate the risk-benefit of reperfusion treatment in the growing elderly frail population.
BACKGROUND: Frailty is the most important short- and long-term predictor of disability in the elderly and, thus, might influence the clinical outcome of acute treatment of stroke. OBJECTIVE: To evaluate whether frailty predicts short- and long-term all-cause mortality and neurological recovery in elderly patients who underwent reperfusion acute treatment of stroke. METHODS: The study included consecutive patients older than 65 years who underwent reperfusion treatment in a single stroke unit from 2015 to 2016. Predictors of stroke outcomes were assessed including demographics, baseline NIHSS, time to needle, treatment and medical complications. Premorbid frailty was assessed with a comprehensive geriatric assessment including functional, nutritional, cognitive, social and comorbidities status. At three and twelve months, all-cause death and clinical recovery (using modified Rankin scale, mRS) were evaluated. RESULTS: One-hundred and two patients who underwent acute reperfusion treatment for stroke entered the study (mean age 77.5, 65-94 years). Frailty was diagnosed in 32 out of 102 patients and associated with older age (p = 0.001) but no differences in baseline NIHSS score, vascular risk profile or treatment management strategy. Frailty status was associated with worse improvement at 24 h and higher in-hospital mortality. At follow-up, frail patients showed poorer survival at 3 (25% vs 3%, p = 0.008) and 12 (38% vs 7%, p = 0.001) months. Frailty was the best predictor of neurological recovery at one year follow-up (mRS 3.2 ± 1.9 vs 1.9 ± 1.9). DISCUSSION: Frailty is an important predictor of efficacy of acute treatment of stroke beyond classical predictors of stroke outcomes. Larger longitudinal studies are, thus, warranted to evaluate the risk-benefit of reperfusion treatment in the growing elderly frail population.
Authors: Ilaria Casetta; Enrico Fainardi; Giovanni Pracucci; Valentina Saia; Fabrizio Sallustio; Valerio da Ros; Sergio Nappini; Patrizia Nencini; Guido Bigliardi; Sergio Vinci; Francesco Grillo; Sandra Bracco; Rossana Tassi; Mauro Bergui; Paolo Cerrato; Andrea Saletti; Alessandro De Vito; Roberto Gasparotti; Mauro Magoni; Luigi Simonetti; Andrea Zini; Maria Ruggiero; Marco Longoni; Lucio Castellan; Laura Malfatto; Paola Castellini; Mirco Cosottini; Alessio Comai; Enrica Franchini; Emilio Lozupone; Giacomo Della Marca; Edoardo Puglielli; Alfonsina Casalena; Claudio Baracchini; Daniele Savio; Enrica Duc; Giuseppe Ricciardi; Manuel Cappellari; Luigi Chiumarulo; Marco Petruzzellis; Anna Cavallini; Nicola Cavasin; Adriana Critelli; Nicola Burdi; Giovanni Boero; Andrea Giorgianni; Maurizio Versino; Francesco Biraschi; Ettore Nicolini; Simone Comelli; Maurizio Melis; Riccardo Padolecchia; Tiziana Tassinari; Nunzio Paolo Nuzzi; Simona Marcheselli; Simona Sacco; Paolo Invernizzi; Ivan Gallesio; Delfina Ferrandi; Maria Fancello; Maria Valeria Saddi; Monia Russo; Aldo Pischedda; Antonio Baule; Marina Mannino; Francesco Florio; Vincenzo Inchingolo; Maria Elena Flacco; Daniele Romano; Umberto Silvagni; Domenico Inzitari; Salvatore Mangiafico; Danilo Toni Journal: Eur Stroke J Date: 2022-04-07
Authors: Jennifer K Burton; Jennifer Stewart; Mairi Blair; Sinead Oxley; Amy Wass; Martin Taylor-Rowan; Terence J Quinn Journal: Age Ageing Date: 2022-03-01 Impact factor: 12.782