Association Between Frailty And Serum Albumin Level And Post-Stroke Cognitive Impairment In Patients With Acute Ischemic Stroke

Research background and purpose:Stroke is the leading cause of death and disability in China,while post stroke cognitive impairment(PSCI)seriously affected the quality of life of patients after stroke and greatly increased the social and family economic burden.So far,the early prediction methods for PSCI in clinical practice were inadequate,the early warning system for PSCI was not perfect,and then leading to the lack of specificity and effectiveness of PSCI treatment methods.Therefore,early identification and intervention of PSCI was an important strategy for prevention and treatment of PSCI.But the early warning markers of PSCI were still in the exploratory stage.Frailty is a state of which a decrease in the physiological reserve of multiple systems and then leads to an increase in the vulnerability of the body.Frailty increased the risk of adverse outcomes in elderly cardiovascular patients.Albumin is a multifunctional protein in blood,which has the functions of maintain body nutrition,anti-inflammatory,inhibition of platelet aggregation and so on.Recent studies have shown the potential association between albumin and frailty.Furthermore,frailty and albumin are closely associated with stroke and its prognosis,and they are also associated with cognitive impairment and dementia.However,no study has investigated the association between the above two markers and PSCI now.In this prospective cohort study,we preliminarily investigated the association among frailty,albumin and PSCI,but the mechanism of PSCI was complex,so it might be necessary to combine the markers of different physiological pathways to give early warning to PSCI.Therefore,our study further investigated the association between frailty combined serum albumin and PSCI,for providing theoretical basis for the risk factors and early warning markers of PSCI.Materials and Methods:This study consecutively recruited patients with first acute ischemic stroke who admission in the Department of Neurology of General Hospital of Western Theater Command from July 2017 to November 2019,older than 50 years of age,and within 48 hours of onset.FRAIL scale was used to assess patient frailty status within 24 hours after admission.All patients were divided into the frailty group(FRAIL score ?3 points)and the non-frailty group(FRAIL score < 3 points)according to the frailty assessment score.Blood samples were collected in the morning of the next day after the patient admission,and serum albumin was detected by professional clinical laboratory staff.Serum albumin concentration ? 40g/L was defined as low albumin level.Cognitive function was assessed by mini-mental State Examination(MMSE)within 24 h and at 3 months after stroke,respectively,and MMSE scores ?26 was defined as cognitive impairment.Patients were divided into PSCI group and non-PSCI group according to 3-month MMSE score.In addition,on the basis of frailty grouping,patients were divided into nonfrailty/normal albumin group,non-frailty/low albumin group,frailty/normal albumin group,and frailty/low albumin group,which according to the serum albumin levels of patients.Results:1.Patient selection process and baseline characteristics: in this study,a total of 397 patients with acute ischemic stroke who met the inclusion criteria were recruited,146 patients who met the exclusion criteria and 32 patients who were lost to follow-up were excluded.Finally,219 patients were included in the statistical analysis.There were 145 PSCI patients(66.21%),68 frailty patients(31.05%),89 patients(40.64%)with low albumin level,and the average serum albumin concentration was 40.64±3.44g/L.There were significant differences in age,LDL-C,CRP,and proportion of hypertension between non-PSCI group and PSCI group.Gender,BMI,education level,MMSE score on admission,NIHSS score on admission and other baseline characteristics showed no significant difference between non-PSCI group and PSCI group.There were significant differences in age,CRP,HDL-C,and proportion of CAD between non-frailty group and frailty group.Gender,BMI,MMSE score on admission,NIHSS score on admission and other baseline characteristics showed no significant difference between non-frailty group and frailty group.2.Association between frailty and PSCI: the proportion of frailty and high FRAIL score in PSCI patients was significantly higher than that in non-PSCI patients.The FRAIL score was negatively correlated with 3-month MMSE score in all patients.Logistic regression results showed that frailty(OR=3.451,95%CI: 1.584-7.518,P=0.002),FRAIL score 3 point(OR=3.688,95%CI: 1.329-10.230,P=0.012)and 4+ point(OR=7.627,95%CI: 1.852-31.412,P=0.005)were significantly associated with PSCI.3.Association between serum albumin and PSCI: the serum albumin concentration and the proportion of low albumin level in PSCI patients were significantly higher than those in non-PSCI patients.Serum albumin concentration was positively correlated with 3-month MMSE score in all patients.Logistic regression results showed that decreased serum albumin concentration(OR=0.791,95%CI: 0.708-0.884,P<0.001)and low albumin level were significantly associated with PSCI(OR=2.976,95%CI: 1.492-5.939,P=0.002).4.Association between frailty and serum albumin: the serum albumin concentration and the proportion of low albumin level in frailty patients were significantly higher than that in non-frailty patients.The serum albumin concentration was negatively correlated with the FRAIL score in all patients.Logistic regression showed that decreased serum albumin concentration(OR=0.801,95%CI: 0.720-0.892,P<0.001)and low albumin level(OR=2.815,95%CI: 1.479-5.361,P=0.002)were associated with frailty.5.Association between frailty combined serum albumin and PSCI: Logistic regression results showed that patients with frailty combined with low albumin level were more likely to have PSCI(OR=7.166,95%CI: 2.233-22.992,P=0.001).Conclusions:1.Pre-stroke frailty might be an independent risk factor of cognitive decline in patients with acute ischemic stroke at 3 months after onset.2.Low serum albumin level might be an independent risk factor of cognitive decline in patients with acute ischemic stroke at 3 months after onset.3.Both frailty and low serum albumin level might be the early warning markers of PSCI.However,the markers of a single physiological pathway might be difficult to accurately predict the occurrence and development of PSCI.Therefore,frailty combined with serum albumin might more accurately predict the occurrence of PSCI.