Association of baseline frailty status with clinical outcome following aneurysmal subarachnoid hemorrhage

Alis J Dicpinigaitis; Matthew K McIntyre; Fawaz Al-Mufti; Syed Faraz Kazim; Boyi Li; Meic H Schmidt; Chirag D Gandhi; Chad D Cole; Christian A Bowers

doi:10.1016/j.jstrokecerebrovasdis.2022.106394

Association of baseline frailty status with clinical outcome following aneurysmal subarachnoid hemorrhage

J Stroke Cerebrovasc Dis. 2022 May;31(5):106394. doi: 10.1016/j.jstrokecerebrovasdis.2022.106394. Epub 2022 Feb 19.

Authors

Alis J Dicpinigaitis¹, Matthew K McIntyre², Fawaz Al-Mufti³, Syed Faraz Kazim⁴, Boyi Li⁵, Meic H Schmidt⁴, Chirag D Gandhi³, Chad D Cole⁴, Christian A Bowers⁶

Affiliations

¹ School of Medicine, New York Medical College, Valhalla, NY 10595.
² Department of Neurological Surgery, Oregon Health and Science University, Portland, OR 97239.
³ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595.
⁴ Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87106.
⁵ Department of Neurosurgery, University of North Carolina Medical Center, Chapel Hill, NC 27599.
⁶ Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87106. Electronic address: CABowers@salud.unm.edu.

PMID: 35193027
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106394

Abstract

Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent neurosurgical condition associated with high morbidity and mortality. The prognostic significance of baseline frailty status in aSAH patients has not been previously evaluated in a large, nationally representative sample.

Materials and methods: Clinical outcomes data from the National Inpatient Sample from 2010-2018 were compared among sub-cohorts stratifying admissions by increasing frailty thresholds [(assessed using the 11-point modified frailty index (mFI-11)]. The previously validated NIS-SAH Severity Score (NIS-SSS) and NIS-SAH Outcome Measure (NIS-SOM) were utilized. Complex samples multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess adjusted associations and discrimination of frailty for endpoints.

Results: Among 64,102 aSAH hospitalizations (mean age 55.4 years), 20.4% of admissions were classified as robust (mFI=0), 43.4% as pre-frail (mFI = 1), 24.9% as frail (mFI = 2), and 11.2% as severely frail (mFI ≥ 3). Following multivariable analysis adjusting for age and aSAH severity, increasing frailty was independently associated with NIS-SOM (OR = 1.15, 95% CI 1.09-1.21; p < 0.001), extended length of hospital stay (eLOS) (OR = 1.08, 1.02-1.13; p = 0.008), neurological complications (OR = 1.08, 1.03-1.13; p < 0.001), and medical complications (OR = 1.14, 1.08-1.21; p < 0.001). Based on ROC curve analysis, frailty achieved an AUC of 0.59 (0.58-0.60) and 0.54 (0.53-0.55) for NIS-SOM and eLOS, respectively. Age and NIS-SSS demonstrated significantly greater discrimination for NIS-SOM [AUC 0.69 (0.68-0.70) and 0.79 (0.78-0.80), respectively), while NIS-SSS achieved significantly greater discrimination for eLOS [(AUC 0.74 (0.73-0.75)] in comparison to both age and frailty.

Conclusions: This national database evaluation of frailty in aSAH patients demonstrates an independent association between increasing frailty and poor functional outcome. Age and aSAH severity, however, may be more robust prognostic factors.

Keywords: Aneurysm; Database; Frailty; Outcomes; Subarachnoid hemorrhage.

MeSH terms

Frailty* / complications
Frailty* / diagnosis
Frailty* / epidemiology
Hospitalization
Humans
Inpatients
Length of Stay
Middle Aged
Retrospective Studies
Subarachnoid Hemorrhage* / complications
Subarachnoid Hemorrhage* / diagnosis
Subarachnoid Hemorrhage* / therapy
Treatment Outcome