Prevalence and outcome of pre-onset frailty in patients with acute stroke

Figures & data

Figure 1. Flow diagram of participant selection.

CFS, clinical frailty scale; SU, Stroke Unit

Table 1. Comparison of clinical characteristics between the non-frail and frail groups.

Variable	Total	Non-frail	Frail	p value
	n = 210	n = 146	n = 64
Age, years, average (SD)	79.2 ± 7.4	77.5 ± 6.6	83.2 ± 7.7	<0.001
Men, n (%)	121 (58)	94 (64)	27 (42)	0.003
Body mass index, kg/m,^Citation2 average (SD)	22.2 ± 3.4	22.9 ± 3.0	20.6 ± 3.6	<0.001
Pre-onset CFS, average (SD)	3.7 ± 1.5	2.8 ± 0.7	5.7 ± 0.9	−
NIHSS score on admission, average (SD)	6.9 ± 7.8	5.8 ± 6.9	9.6 ± 9.1	0.006
NIHSS score on day 7, average (SD)	4.6 ± 6.5	3.7 ± 5.4	6.4 ± 8.1	0.009
Stroke type, infarct, n (%)	185 (88)	125 (86)	59 (92)	0.219
Risk factors, n (%)
Previous stroke	49 (23)	23 (16)	26 (41)	<0.001
Hypertension	153 (73)	101 (69)	52 (81)	0.094
Diabetes mellitus	61 (29)	44 (30)	17 (27)	0.579
Dyslipidemia	81 (39)	57 (39)	24 (38)	0.804
Smoking	99 (47)	74 (51)	25 (39)	0.110
Arterial fibrillation	39 (19)	18 (12)	21 (33)	<0.001
Ischemic heart disease	16 (8)	10 (7)	6 (9)	0.268
Outcome parameters
mRS at discharge, average (SD)	2.5 ± 1.7	2.2 ± 1.7	3.3 ± 1.3	<0.001
NIHSS score on discharge, average (SD)	4.4 ± 6.6	3.5 ± 5.7	6.4 ± 8.1	0.002
Days of hospitalization, day, average (SD)	18.6 ± 12.8	17.9 ± 12.1	20.2 ± 14.4	0.312
Discharge from hospital, Home, n (％)	93 (44)	72 (49)	21 (33)	0.062

CFS, clinical frailty scale; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin scale; SD, standard deviation.

Figure 2. Distribution of pre-onset CFS scores. the prevalence of frailty (CFS score ≥ 5) is 31, 24, and 47% in the overall, first-onset, and recurrent groups, respectively. The distribution peak is at a CFS score of 3.

CFS, clinical frailty scale

Table 2. Comparison of clinical background characteristics by functional disability at discharge.

Variable	mRS ≤2	mRS ≥3	p value
	n = 99	n = 111
Age, years, average (SD)	77.7 ± 7.0	80.6 ± 7.5	0.004
Men, n (%)	67 (68)	54 (49)	0.010
Body mass index, kg/m,^Citation2 average (SD)	22.8 ± 3.0	21.7 ± 3.6	0.020
Preadmission frailty (CFS ≥5), n (%)	15 (15)	49 (44)	<0.001
NIHSS score on admission, average (SD)	2.7 ± 3.9	10.6 ± 8.5	<0.001
NIHSS score on day 7, average (SD)	0.9 ± 1.7	7.9 ± 7.5	<0.001
Stroke type, infarct, n (%)	94 (95)	90 (81)	0.001
Risk factors, n (%)
Previous stroke	15 (15)	34 (31)	0.009
Hypertension	75 (76)	78 (70)	0.250
Diabetes mellitus	28 (28)	33 (30)	0.854
Dyslipidemia	46 (46)	35 (32)	0.023
Smoking	53 (54)	46 (41)	0.068
Arterial fibrillation	11 (11)	28 (25)	0.010
History of vascular disease	7 (7)	9 (8)	0.677
Outcome parameters
NIHSS score on discharge, average (SD)	0.7 ± 1.3	7.8 ± 7.6	<0.001
Days of hospitalization, day, average (SD)	14.9 ± 8.3	22.0 ± 15.1	<0.001
Discharge from hospital, home, n (％)	80 (81)	13 (12)	<0.001

CFS, clinical frailty scale; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale; SD, standard deviation.

Table 3. Logistic regression analysis of predictors of poor discharge outcome (mRS ≥3).

	Odds ratio (95% CI)	p value
Age	0.995 (0.941–1.052)	0.853
Sex (male)	0.662 (0.309–1.418)	0.288
BMI	0.960 (0.862–1.070)	0.463
CFS	1.486 (1.128–1.958)	0.005
NIHSS	1.210 (1.119–1.307)	<0.001
Stroke type	3.249 (0.862–12.248)	0.082
Previous stroke	2.575 (1.086–6.107)	0.032
Dyslipidemia	0.702 (.336–1.467)	0.346
Arterial fibrillation	1.119 (0.384–3.264)	0.836

CFS, clinical frailty scale; NIHSS, National Institutes of Health Stroke Scale; BMI, body mass index; CI, confidence interval.

Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, Gotoh S, et al. Secular trends in cardiovascular disease and its risk factors in Japanese: half-century data from the hisayama study (1961-2009). Circulation. 2013;128(11):1198–1205. doi:10.1161/CIRCULATIONAHA.113.002424.

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