Overlapping premorbid frailty, multimorbidity, and malnutrition and their associations with poor outcomes in patients with stroke

Aim: This study aimed to explore the prevalence of these overlapping premorbid geriatric conditions¬ and examine the association between the number of these conditions and the risk of mortality and major cardiovascular events within one year after acute stroke. Methods: In this single-centre prospective cohort study, consecutive stroke patients admitted between November 2020 and September 2024 were enrolled. Premorbid frailty was assessed using the 33-item Rockwood Frailty Index. Multimorbidity was defined as the presence of two or more chronic comorbidities other than stroke. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. Patients were categorized according to the number of overlapping conditions (NOC), ranging from 0 to 3. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events within one year after admission. Cox proportional hazards regression models adjusted for potential confounders were used to estimate adjusted hazard ratios (HR). Results: Among 781 patients (mean age 77.9 ±12.6 years; 390 [49.9%] female), 226 patients (28.9%) were NOC 0, 289 (37.0%) were NOC 1, 161 (20.6%) were NOC 2, and 105 (13.4%) were NOC 3. Compared with NOC 0, the adjusted HRs for the composite outcome were 1.52 (95% CI 0.86–2.68) for NOC 1, 2.64 (95% CI 1.44–4.85) for NOC 2, and 5.20 (95% CI 2.77–9.73) for NOC 3. Conclusions: One-third of patients with acute stroke had overlapping premorbid geriatric conditions. The number of overlapping conditions was significantly associated with a composite event in a dose-response manner.