背景:衰弱在卒中患者中常见,并与不良结局相关。然而,在研究出院成年卒中患者基线虚弱与短期预后之间的因果关系的纵向研究中仍存在差距.
目的:研究虚弱对非选择性再入院和主要不良心脑事件的因果影响,并调查其与认知障碍和卒中后残疾的关系。
方法:多中心前瞻性队列研究。
方法:中国中部和西北地区的两家三级医院。
方法:从2022年1月至2022年6月纳入卒中单元的667名成年卒中患者。
方法:用虚弱量表评估基线虚弱。使用定制设计的问题来评估非选择性再入院和主要不良心脏和大脑事件作为主要结果。认知障碍,使用简易精神状态检查量表(MMSE)进行评估,和中风后残疾,用改良的兰金量表(mRS)测量,在3个月随访时被认为是次要结局.使用双变量和多重Cox回归分析检查了基线虚弱对非选择性再入院和主要不良心脑事件的影响。此外,基线虚弱和认知障碍之间的关联,或中风后残疾,通过广义线性模型进行了研究。
结果:共有5名参与者死亡,12有主要的心脏和大脑不良事件,667例成人卒中患者中有57例非选择性再入院.虚弱是卒中患者非选择性再入院(风险比[HR]:2.71,95%置信区间[CI]:1.59,4.62)和主要不良心脑事件(HR:3.77,95%CI:1.07,13.22)的独立危险因素。基线虚弱与认知障碍(回归系数[β]:-2.68,95%CI:-3.78,-1.58)相关,根据社会人口统计学和临床因素以及随访间隔进行调整。然而,当进一步调整基线MMSE时,虚弱与认知障碍之间的关系未达到统计学意义(β:-0.39,95%CI:-1.43,0.64).此外,基线虚弱与卒中后残疾相关(β:0.36,95%CI:0.08,0.65),调整社会人口统计学和临床变量,随访间隔,和基线mRS。
结论:这一发现强调了评估出院成年卒中患者基线虚弱的重要性,因为它与非选择性再入院显著相关,主要不良心脏和大脑事件,和3个月时的卒中后残疾。这些结果强调了筛查和评估虚弱状态在改善成年卒中患者短期预后中的关键作用。应制定干预措施以解决基线虚弱并减轻卒中的短期预后。
结论:基线虚弱预测非选择性再入院,主要不良心脏和大脑事件,和成年中风患者的中风后残疾。@haiyanhexyyy。
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.
METHODS: A multicenter prospective cohort study.
METHODS: Two tertiary hospitals in Central and Northwest China.
METHODS: 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.
CONCLUSIONS: Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.