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. 2024 Jan 25:16:1305803.
doi: 10.3389/fnagi.2024.1305803. eCollection 2024.

To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke?

Luana Aparecida Miranda  1 , Gustavo José Luvizutto  2 , Pedro Augusto Cândido Bessornia  1 , Natalia Eduarda Furlan  1 , Fernanda Cristina Winckler  1 , Natalia Cristina Ferreira  1 , Pedro Tadao Hamamoto Filho  1 , Juli Thomaz de Souza  1 , Luis Cuadrado Martin  3 , Silméia Garcia Zanati Bazan  3 , Gabriel Pinheiro Modolo  1 , Carlos Clayton Macedo de Freitas  1 , Edison Iglesias de Oliveira Vidal  3 , Rodrigo Bazan  1
Affiliations

To what extent does frailty mediate the association between age and the outcomes of brain reperfusion following acute ischemic stroke?

Luana Aparecida Miranda et al. Front Aging Neurosci. .

Abstract

Objective: We evaluated the extent to which frailty mediated the association between age, poor functional outcomes, and mortality after acute ischemic stroke when patients were treated with brain reperfusion (thrombolytic therapy and/or thrombectomy).

Materials and methods: This retrospective cohort study included patients diagnosed with ischemic stroke who had undergone intravenous cerebral reperfusion therapy and/or mechanical thrombectomy. We created a mediation model by analyzing the direct natural effect of an mRS score > 2 and death on age-mediated frailty according to the Frailty Index.

Results: We enrolled 292 patients with acute ischemic stroke who underwent brain reperfusion. Their mean age was 67.7 ± 13.1 years. Ninety days after the stroke ictus, 54 (18.5%) participants died, and 83 (28.4%) lived with moderate to severe disability (2 < mRS < 6). In the mediation analysis of the composite outcome of disability (mRS score > 2) or death, frailty accounted for 28% of the total effect of age. The models used to test for the interaction between age and frailty did not show statistically significant interactions for either outcome, and the addition of the interaction did not significantly change the direct or indirect effects, nor did it improve model fit.

Conclusion: Frailty mediated almost one-third of the effect of age on the composite outcome of disability or death after acute ischemic stroke.

Keywords: brain reperfusion; frailty; stroke; thrombectomy; thrombolytic therapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Graphical representation of frailty as a mediator of the association between age and stroke outcomes.
Figure 2
Figure 2
Participant selection flowchart. TIA, Transient ischemic attack; IV, Intravenous thrombolysis; MT, Mechanical thrombectomy.
Figure 3
Figure 3
Graphical representation of the results of the mediation analysis for the composite outcome of disability or death (modified Rankin Scale >2) 90 days after the stroke ictus. All regressions underlying the mediation analysis, the coefficients of which are shown in the figure, were adjusted for sex, race, National Institutes of Health Stroke Scale score, and smoking status. NIE, natural indirect effect; NDE: Natural direct effect; OR: Odds ratio; CI: Confidence interval; mRS, modified Rankin Scale.
Figure 4
Figure 4
Graphical representation of the results of the mediation analysis for the 90-day mortality outcome. All regressions underlying the mediation analysis, the coefficients of which are shown in the figure, were adjusted for sex, race, National Institutes of Health Stroke Scale score, and smoking status. NIE, Natural indirect effect; NDE, Natural direct effect; OR, Odds ratio; CI, Confidence interval.
See this image and copyright information in PMC

References

    1. Alter M. (1994). Black-white differences in stroke frequency: challenges for research. Neuroepidemiology 13, 301–307. doi: 10.1159/000110395, PMID: - DOI - PubMed
    1. Baggio J. A. O., Santos-Pontelli T. E. G., Cougo-Pinto P. T., Camilo M., Silva N. F., Antunes P., et al. (2014). Validation of a structured interview for telephone assessment of the modified Rankin scale in Brazilian stroke patients. Cerebrovasc. Dis. 38, 297–301. doi: 10.1159/000367646, PMID: - DOI - PubMed
    1. Cincura C., Pontes-Neto O. M., Neville I. S., Mendes H. F., Menezes D. F., Mariano D. C., et al. (2009). Validation of the National Institutes of Health stroke scale, modified Rankin scale and Barthel index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc. Dis. 27, 119–122. doi: 10.1159/000177918, PMID: - DOI - PMC - PubMed
    1. Evans N. R., Wall J., To B., Wallis S. J., Romero-Ortuno R., Warburton E. A. (2020). Clinical frailty independently predicts early mortality after ischaemic stroke. Age Ageing 49, 588–591. doi: 10.1093/ageing/afaa004, PMID: - DOI - PubMed
    1. Fox J. (2016). Applied regression analysis and generalized linear models. SAGE, Los Angeles. ISBN: 978-1-4522-0566-3.

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