Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke

Abstract

Purpose Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Methods Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0–2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis. Results Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33–0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52–1.27, p = 0.362). Conclusion Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.

Self-reported life-space mobility in the first year after ischemic stroke: longitudinal findings from the MOBITEC-Stroke project

“…Our findings also suggest that the presence of comorbidities was associated with the course of LSA after stroke—with higher LSA scores in those with fewer (0–1 vs ≥ 2) comorbidities. To the best of our knowledge, there are no previous reports on the association between comorbidities and life-space mobility in patients after stroke; however, comorbidities have repeatedly been shown to be prognostic of functional recovery, participation in life situations and survival post-stroke [ 4 , 47 – 50 ]. The presence of comorbidities in patients after stroke may affect life-space mobility through various biopsychosocial pathways; besides potentially causing additional physical, cognitive or perceptual deficits, they may also contribute to an increased psychological distress [ 51 ] as well as physical and mental fatigue [ 52 ].…”

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

“…Future work in pre-hospital and hospital settings should also consider combining physiological factors with other nonstroke characteristics which may have a bearing on thrombectomy outcome such as frailty, pre-stroke dependency and comorbidities (Adamou et al, 2022;Tan et al, 2022;Barow et al, 2023). Although some have been included in previously published thrombectomy outcome scores (Kremers et al, 2021), especially pre-stroke dependency, it has not yet been demonstrated that they are accurate when used by non-specialist practitioners making early triage decisions towards thrombectomy providers.…”

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

“…В одном из исследований, в котором для оценки мультиморбидности в острой стадии инсульта использовали модифицированный индекс Чарльсон, было показано, что неблагоприятные исходы возникали чаще у больных со значениями модифицированного индекса Чарльсон ≥2. Эта зависимость сохранялась при проведении многомерного регрессионного анализа [475]. В исследовании у больных с ишемическим инсультом высокая степень мультиморбидности (оценивали с помощью индекса Чарльсон) ассоциировалась с более высокими показателями госпитальной летальности [476].…”