# Frailty diminishes functional outcome in patients with nonaneurysmal subarachnoid hemorrhage: a dual specialized neurovascular center analysis

## TL;DR

Frailty before a nonaneurysmal subarachnoid hemorrhage is linked to worse recovery outcomes six months later.

## Contribution

This study shows frailty is an independent predictor of poor outcomes in nonaneurysmal subarachnoid hemorrhage patients.

## Key findings

- Frail patients had a 30% unfavorable outcome rate versus 10% in nonfrail patients at 6 months.
- Frailty was identified as an independent predictor of poor outcomes alongside known factors like delayed cerebral ischemia.
- Frailty assessment using the modified frailty index helps guide early patient management and counseling.

## Abstract

Frailty is increasingly recognized as a significant prognostic factor in various conditions. However, its impact on outcomes following spontaneous, nonaneurysmal subarachnoid hemorrhage (naSAH) remains unclear. This study aimed to assess the association between pre-existing frailty and functional outcomes in patients with naSAH.

The study cohort was made up of 257 patients treated for naSAH at two neurovascular centers between 2012 and 2021. Frailty prior to naSAH was assessed using the modified frailty index (mFI), with patients classified as nonfrail (mFI 0–1) or frail (mFI ≥ 2). Functional outcomes at 6 months were evaluated using the modified Rankin Scale (mRS), categorized as favorable (mRS 0–2) or unfavorable (mRS 3–6). A multivariable logistic regression analysis was performed to identify independent predictors of unfavorable outcomes.

Among 257 naSAH patients, 56 (22%) were classified as frail (mFI ≥ 2) before ictus. At the 6-month follow-up, unfavorable outcomes were observed in 17 of the 56 frail patients (30%) compared to 21 of 201 nonfrail patients (10%) (p = 0.001). In addition to established negative prognostic factors such as delayed cerebral ischemia (p < 0.001) and poor-grade naSAH (Hunt & Hess grades III–IV; p = 0.001), multivariable analysis identified frailty (p = 0.03) as an independent and significant predictor of unfavorable functional outcomes.

Frailty prior to hemorrhage, as determined by an mFI of ≥ 2, was associated with poor functional outcomes at 6 months in patients with naSAH. These findings underscore the importance of incorporating frailty assessments into early prognostic evaluations to guide patient management and counseling.