BACKGROUND Frailty-the loss of physiological reserve to withstand a stressor event-is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke. METHODS Total ischemic lesion volumes (comprising infarct core and penumbral volumes) were measured using computed tomography (CT) perfusion imaging to give the penumbral fraction within the ischemic lesion. Pre-stroke frailty was measured using a validated frailty index. The relationship between frailty and penumbral fraction was adjusted for age, onset-to-CT interval, collateral scores, small vessel disease burden and vascular comorbidities. Stroke severity was measured using the National Institutes of Health Stroke Scale at baseline and after 24 h. RESULTS In 55 individuals receiving thrombolysis for ischemic stroke, increasing frailty was associated with a reduction in penumbral fraction (rs = -0.36, P < 0.01). This remained significant after adjustment for age, onset-to-imaging time and collateral score (beta = -1.16, P < 0.001). Correspondingly, frailty was independently negatively associated with proportional improvement in stroke severity following treatment (beta = -2.00, P < 0.01). C-reactive protein (CRP) on presentation was associated with frailty index (rs = 0.38, P < 0.01) and penumbral fraction (rs = -0.30, P = 0.02). DISCUSSION A reduction in salvageable penumbra in frailty may explain the treatment-attenuating effects of frailty on reperfusion therapies. The association with CRP motivates further research into a possible inflammatory component of this relationship. CONCLUSION Frailty is independently associated with reduced penumbra and poorer neurological recovery in acute stroke. These findings may explain the attenuated response to stroke reperfusion therapies seen in frailer individuals.

中文翻译：

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虚弱会减少半影体积并减弱超急性缺血性卒中的治疗反应。


背景 虚弱 - 承受压力源事件的生理储备的丧失 - 与急性中风再灌注治疗后较差的结果有关。然而，人们对这种关系背后的机制知之甚少。本研究调查了超急性缺血性卒中虚弱与半影体积之间的关联。方法 使用计算机断层扫描 （CT） 灌注成像测量缺血病灶总体积 （包括梗死核心和半影体积），以给出缺血病灶内的半影部分。使用经过验证的虚弱指数测量卒中前虚弱。根据年龄、发病至 CT 间期、附带评分、小血管疾病负荷和血管合并症调整虚弱与半影分数之间的关系。在基线和 24 小时后使用美国国立卫生研究院卒中量表测量中风严重程度。结果 在 55 例接受溶栓治疗缺血性中风的个体中，虚弱程度增加与半影分数降低相关 （rs = -0.36，P < 0.01）。在调整年龄、发病至成像时间和侧支评分后，这仍然显着 （beta = -1.16，P < 0.001）。相应地，虚弱与治疗后卒中严重程度的成比例改善独立负相关 （beta = -2.00，P < 0.01）。C 反应蛋白 （CRP） 与衰弱指数 （rs = 0.38，P < 0.01） 和半影分数 （rs = -0.30，P = 0.02） 相关。讨论 衰弱中可挽救的半影部减少可能解释了衰弱对再灌注治疗的治疗减弱作用。与 CRP 的关联促使进一步研究这种关系中可能的炎症成分。 结论 虚弱与急性卒中半影减少和神经恢复较差独立相关。这些发现可以解释在较虚弱的个体中观察到的对卒中再灌注治疗的反应减弱。