Frailty's influence on older stroke patients: Neurological outcome and mortality after endovascular treatment in stroke: A national German stroke registry analysis

Abstract

Introduction: Frailty is a clinical syndrome particular in old patients with an increased risk of adverse health-care events. In geriatric stroke patients who received endovascular treatment, monocentric analyses have demonstrated that frailty affects mortality and functional outcome. We aimed to investigate the impact of frailty in a larger multicentric cohort.

Patients and methods: We analyzed the impact of frailty on outcome in patients with stroke who underwent endovascular treatment in seven academic centers contributing to the German Stroke Registry. We calculated the Hospital Frailty Risk Score (HFRS) for all patients aged ⩾ 65 years. Functional outcome was measured by modified Rankin Scale (mRS) 3 months after the stroke event. A regression analysis conducted to assess mortality and functional outcome, adjusted for factors known to influence outcomes.

Results: 2468 patients fulfilled the inclusion criteria. Median HFRS was 1.1 (IQR 0-2.95) and 449 (18.2%) patients had HFRS > 5. Low, intermediate and high-frailty risk was present in 2009 (71.7%), 389 (15.8%), and 60 (2.44%) respectively. A favorable neurological outcome (mRS 0-2) was achieved in 31.7%, 20.6%, and 13.8% in the low-, moderate, and high-risk-frailty-groups respectively (p < 0.001). Multivariate regression analysis showed a significant associations of HFRS on both mortality (adjusted OR 1.033, 95% CI: 1.004-1.063, p = 0.024) and functional outcome (adjusted OR: 0.962, 95% CI: 0.929-0.997; p = 0.033) after 3 months. However, there was no significant difference in baseline NHISS scores between frail and non-frail patients (14 (IQR 19-19)) vs 15 (IQR 11-19) vs 15 (IQR 10-19); p = 0.295). Besides door-to-groin time (DTN) differed with high frailty-risk patients having the longest DTN times (64 (38-102) vs 67.5 (45-95) vs 80 (54-106); p = 0.020).

Discussion and conclusion: We identified frailty as a factor strongly associated with both mortality and functional outcome in ischemic stroke patients undergoing thrombectomy.

Keywords: Endovascular treatment; frailty; functional outcome.

Graphical abstract

Figure 1.

Flowchart of patient selection.

Figure 2.

Functional outcome measured by the modified Rankin Scale after 90 days.