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Premorbid frailty predicts short- and long-term outcomes of reperfusion treatment in acute stroke

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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.

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Authors and Affiliations

  1. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.zale Spedali Civili, 1-25213, Brescia, Italy

    Andrea Pilotto, Andrea Morotti & Alessandro Padovani

  2. FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy

    Andrea Pilotto

  3. Department of Neurology, Kreisklinikum Siegen, Siegen, Germany

    Cora Brass

  4. Department of Neurology, University of the Saarland, Homburg, Saar, Germany

    Klaus Fassbender, Fatma Merzou, Niklas Kämpfer & Piergiorgio Lochner

  5. Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy

    Antonio Siniscalchi

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  1. Andrea Pilotto
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  2. Cora Brass
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  3. Klaus Fassbender
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  4. Fatma Merzou
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  7. Antonio Siniscalchi
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  8. Alessandro Padovani
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  9. Piergiorgio Lochner
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Corresponding author

Correspondence to Andrea Pilotto.

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Conflicts of interest

Competing interest statement regarding the submitted work: None. Competing interest statement outside the submitted work Andrea Pilotto is supported by IMI H2020 initiative (MI2-2018-15-06) paid to the university of Brescia and PRIN funding of the Italian Ministry of Education, Research and University (MIUR) paid to the university of Brescia; he received Lectures honoraria from Bial, Biomarin, Abbvie, CHiesi and Zambon pharmaceuticals-payment made to A.P. as an individual; he received research support from Bial, Biomarin, Abbvie, CHiesi and Zambon pharmaceuticals-payment made to the Institution University of Brescia, Klaus Fassbender, Fatma Merzou, Andrea Morotti, Niklas Kämpfer and Antonio Siniscalchi have no conflict of interests. Alessandro Padovani received grant support from Ministry of Health (MINSAL) and Ministry of Education, Research and University (MIUR), from CARIPLO Foundation; personal compensation as a consultant/scientific advisory board member for Biogen 2019–2020–2021 Roche 2019–2020 Nutricia 2020–2021 General Healthcare (GE) 2019; he received honoraria for lectures at meeting ADPD2020 from Roche, Lecture at meeting of the Italian society of Neurology 2020 from Biogen and from Roche, Lecture at meeting AIP 2020 and 2021 from Biogen and from Nutricia, Educational Consulting 2019–2020–2021 from Biogen. Piergiorgio Lochner has no conflict of interest.

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Pilotto, A., Brass, C., Fassbender, K. et al. Premorbid frailty predicts short- and long-term outcomes of reperfusion treatment in acute stroke. J Neurol 269, 3338–3342 (2022). https://doi.org/10.1007/s00415-022-10966-7

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  • DOI: https://doi.org/10.1007/s00415-022-10966-7

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