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A laboratory-based frailty index predicts mortality in ischemic stroke with carotid artery stenosis: a retrospective
Muyuan Li1,2, Xiaoxin He1,2, Xuebing Feng1,2
1Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Insights
A laboratory-based frailty index (FI-Lab) effectively predicts short- and long-term mortality in patients with ischemic stroke (IS) due to carotid artery stenosis (CAS). Higher FI-Lab scores indicate increased mortality risk.
Area of Science:
- Neurology
- Gerontology
- Critical Care Medicine
Background:
- Ischemic stroke (IS) secondary to carotid artery stenosis (CAS) is a leading cause of death and disability worldwide.
- Frailty, a state of physiological decline, is an emerging prognostic indicator across various medical conditions.
Purpose of the Study:
- To assess the prognostic value of a laboratory-based frailty index (FI-Lab) for short- and long-term mortality in patients with IS-CAS.
- To explore the association between FI-Lab scores and mortality outcomes in this patient population.
Main Methods:
- Retrospective analysis of 1,869 patients with IS-CAS from the MIMIC-IV database.
- Calculation of FI-Lab using 33 routine laboratory tests within 24 hours of ICU admission.
- Statistical analysis including Cox proportional hazards models, restricted cubic splines, and Kaplan-Meier curves.
Main Results:
- Higher FI-Lab scores were independently associated with increased 30-day and 1-year mortality in IS-CAS patients (p < 0.001).
- A linear association was observed between FI-Lab scores and mortality risk.
- Consistent mortality prediction trends were noted in subgroup analyses, particularly in non-ventilated patients.
Conclusions:
- The laboratory-based frailty index (FI-Lab) is a reliable predictor of mortality in patients with IS-CAS.
- FI-Lab can aid in individualized risk stratification and clinical decision-making for stroke management.
Abstract:
Ischemic stroke (IS), particularly due to carotid artery stenosis (CAS), is a major global contributor to mortality and disability. Frailty, characterized by systemic physiological decline and reduced homeostatic reserves, has emerged as a powerful prognostic marker across a wide range of diseases. We aimed to evaluate the prognostic utility of a laboratory-based frailty index (FI-Lab) in patients with IS secondary to CAS (IS-CAS), focusing on short- and long-term mortality. Data were extracted from the MIMIC-IV database. FI-Lab was calculated using 33 routine tests within 24 h of ICU admission. Patients were stratified into quartiles based on FI-Lab scores. Cox proportional hazards models, restricted cubic splines, Kaplan-Meier curves, and subgroup analyses were applied. Among 1,869 IS-CAS patients, higher FI-Lab scores were independently associated with increased 30-day and 1-year mortality (p for trend < 0.001). The highest quartile had a significantly elevated hazard ratio compared to the lowest. Survival curves and RCS analyses supported a linear association. Subgroup analysis showed consistent trends, especially in patients not receiving mechanical ventilation. FI-Lab is a robust predictor of both short- and long-term mortality in IS-CAS. It holds promise for individualized risk stratification and could aid clinical decision-making in stroke management.
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