Abstract
Background
Lacunar strokes (LS) are ischemic strokes of the small perforating arteries of deep
gray and white matter of the brain. Frailty has been associated with greater mortality
and attenuated response to treatment after stroke. However, the effect of frailty
on patients with LS has not been previously described.
Objective
To analyze the association between frailty and outcomes in LS.
Methods
Patients with LS were selected from the National Inpatient Sample (NIS) 2016-2019
using the International Classification of Disease, 10th edition (ICD-10) diagnosis codes. The 11-point modified frailty scale (mFI-11) was
used to group patients into severely frail and non-severely frail cohorts. Demographics,
clinical characteristics, and complications were defined. Health care resource utilization
(HRU) was evaluated by comparing total hospital charges and length of stay (LOS).
Other outcomes studied were discharge disposition and inpatient death.
Results
Of 48,980 patients with LS, 10,830 (22.1%) were severely frail. Severely frail patients
were more likely to be older, have comorbidities, and pertain to lower socioeconomic
status categories. Severely frail patients with LS had worse clinical stroke severity
and increased rates of complications such as urinary tract infection (UTI) and pneumonia
(PNA). Additionally, severe frailty was associated with unfavorable outcomes and increased
HRU.
Conclusion
Severe frailty in LS patients is associated with higher rates of complications and
increased HRU. Risk stratification based on frailty may allow for individualized treatments
to help mitigate adverse outcomes in the setting of LS.
Keywords
Abbreviations:
Lacunar Strokes ((LS)), hypertension ((HTN)), modified frailty index 11 ((mFI-11)), National Surgical Quality Improvement Project ((NSQIP)), National Inpatient Sample ((NIS)), healthcare resource utilization ((HRU)), atrial fibrillation ((A fib)), hyperlipidemia ((HLD)), chronic renal failure ((CRF)), obstructive sleep apnea ((OSA)), acute kidney injury ((AKI)), aspiration pneumonitis ((AP)), urinary tract infection ((UTI)), pneumonia ((PNA)), deep vein thrombosis ((DVT)), pulmonary embolism ((PE)), length of stay ((LOS)), National Institute of Health stroke scale ((NIHSS)), diabetes mellitus ((DM)), chronic kidney disease ((CKD))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 14, 2022
Accepted:
December 9,
2022
Received in revised form:
December 6,
2022
Received:
September 20,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106942
Copyright
© 2022 Elsevier Inc. All rights reserved.
