Abstract
Background
Clinical frailty is a multifaceted biological phenomenon that arises from a cumulative multisystem decline, resulting in a state of increased vulnerability to stressor events. Here, we investigated the impact of premorbid clinical frailty on outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT).
Methods
This retrospective cohort study included 103 patients (≥70 years) treated with IVT for AIS. Frailty was assessed using the Clinical Frailty Scale (CFS). Primary and secondary endpoints were favorable functional outcomes (defined as a modified Rankin Scale (mRS) score of 0-2) at 30 and 90 days, respectively. Other endpoints included National Institutes of Health Stroke Scale (NIHSS) improvement at 24 h post-IVT, 30-day all-cause mortality, and symptomatic intracerebral hemorrhage (sICH).
Results
Frailty was independently associated with lower odds of achieving favorable functional outcomes at both 30 (adjusted OR 0.01 [95% CI 0.003-0.11], P < .001) and 90 days (adjusted OR 0.03 [95% CI 0.01-0.36], P < .001), and with increased 30-day all-cause mortality (adjusted OR 1.95 [95% CI 1.12-3.96], P < .001). Early neurologic improvement was likewise attenuated among frail patients, with each one-point increase in CFS found to be independently associated with a 1.871-point decrease in NIHSS improvement at 24 h post-IVT (P < .001). Frailty was not independently associated with sICH (adjusted OR 1.36 [95% CI 0.87-3.06], P = .857).
Conclusion
Our findings suggest that premorbid clinical frailty is independently associated with worse outcomes among patients receiving IVT for AIS, without significantly increasing the risk of sICH.
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