The effect of frailty on mortality and functional outcomes in spontaneous intracerebral haemorrhage

• Published in: Clinical neurology and neurosurgery Vol. 246; p. 108539
• Main Authors: Ong, Shi Hui, Tan, Ashlee Yi Xuan, Tan, Benjamin, Yeo, Leonard, Tan, Li Feng, Teo, Kejia, Yeo, Tseng Tsai, Nga, Vincent Diong Weng, Lim, Mervyn Jun Rui
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2024; Elsevier Limited
• Subjects: Activities of daily living; Age; Aged; Aged, 80 and over; Atrophy; Cardiovascular diseases; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - mortality; Chronic fatigue syndrome; Cognition & reasoning; Decision making; Demographics; Diabetes; Electronic health records; Epidemiology; Female; Females; Frailty; Frailty - complications; Frailty - mortality; Gender; Hematoma; Hemorrhage; Humans; Hypertension; Male; Medical records; Middle Aged; Mortality; Older people; Physiology; Regression analysis; Retrospective Studies; Risk Factors; Spontaneous intracerebral haemorrhage; Stroke; Survival analysis; Treatment Outcome; Frailty; Spontaneous intracerebral haemorrhage; Epidemiology; Mortality
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108539

Limited data in patients with spontaneous intracerebral haemorrhage (SICH) showed that frailty was associated with mortality; however, there was insufficient data on functional outcomes. This study aimed to investigate the effect of frailty on overall mortality and 90-day functional outcomes in SICH. We conducted a retrospective study of 1223 patients diagnosed with SICH from January 2014 to December 2020. Frailty was defined as a clinical frailty scale (CFS) score of 4–9. Binary cut-offs were defined using receiver operating curve analysis. 90-day poor functional outcomes (PFO) were defined as modified Rankin Scale (mRS) ≥3, and utility-weighted mRS (UW-mRS) were based on previous validated studies respectively. Regression analyses were conducted to investigate the association between frailty and outcomes. Confounders adjusted for included demographics, cardiovascular risk factors and haematoma characteristics. 1091 patients met the inclusion criterion. 167 (15.3 %) had 30-day mortality and 730 (66.9 %) had 90-day PFO. Frailty was significantly associated with lower overall survival (HR: 1.54; 95 % CI: 1.11–2.14, p=0.010), 90-day PFO (OR: 1.90; 95 % CI: 1.32–2.74; p<0.001) and poorer UW-mRS (β: −0.06; 95 % CI: (-0.08 to −0.04); p<0.001) even after adjusting for confounders. Frailty was significantly associated with greater mortality and PFO after incident SICH, even after adjusting for a priori confounders. Frail male individuals may be predisposed to poorer outcomes from higher prevalence of cortical atrophy. The use of CFS in younger individuals may aid management by predicting outcomes after incident SICH. Identifying frail individuals with incident SICH could aid in decision-making and the surgical management of SICH. •Frail patients with incident SICH had significantly poorer outcomes.•Those who were males had poorer outcomes than other subgroups.•Use of CFS in younger individuals with incident SICH may guide management.