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Frailty and outcomes in lacunar stroke

      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))
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