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Review
. 2023 Oct 23;13(10):1498.
doi: 10.3390/brainsci13101498.

Frailty as a Predictor of Outcomes in Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Michael Fortunato  1 , Fangyi Lin  1 , Anaz Uddin  1 , Galadu Subah  2 , Rohan Patel  1 , Eric Feldstein  2 , Aiden Lui  1 , Jose Dominguez  2 , Matthew Merckling  1 , Patricia Xu  1 , Matthew McIntyre  3 , Chirag Gandhi  1   2 , Fawaz Al-Mufti  1   2
Affiliations
Review

Frailty as a Predictor of Outcomes in Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Michael Fortunato et al. Brain Sci. .

Abstract

Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates that have previously been shown to correlate with frailty. However, the relationship between treatment selection and post-treatment outcomes in frail aSAH patients is not established. We conducted a meta-analysis of the relevant literature in accordance with PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar using "Subarachnoid hemorrhage AND frailty" and "subarachnoid hemorrhage AND frail" as search terms. Data on cohort age, frailty measurements, clinical grading systems, and post-treatment outcomes were extracted. Of 74 studies identified, four studies were included, with a total of 64,668 patients. Percent frailty was 30.4% under a random-effects model in all aSAH patients (p < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model (p < 0.001). There was no significant difference in mortality rate between frail and non-frail aSAH patients, but this analysis only included two studies and should be interpreted cautiously. Age and clinical grading, rather than frailty, independently predicted outcomes and mortality in aSAH patients.

Keywords: frailty; outcomes; subarachnoid hemorrhage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA study flow diagram demonstrating the number of studies included at each stage of data extraction. Adapted from the PRISMA 2020 flow diagram [28].
Figure 2
Figure 2
Meta-analysis of patient age of all studies revealed an average of 57.8 years under a random-effect model in aSAH patients [26,29,32].
Figure 3
Figure 3
Meta-analysis of frailty percentage of all studies revealed that 30.4% of aSAH populations are frail [26,27,29,32].
Figure 4
Figure 4
The meta-analysis of Fisher scores from the included studies indicated that among the aSAH populations where Fisher scores were reported, the average Fisher score was 3.3 [26,29].
Figure 5
Figure 5
(a) Meta-analysis on available data indicates that the overall mortality rate for frail and non-frail patients with aSAH is 11.7% (CI 7.4–18.1%, p < 0.001) when using a random-effects model [26,27,32]. (b) Meta-analysis on available data indicates that the mortality rate for frail patients with aSAH is 19.5% (CI 8.0–40.2%, p < 0.001) when using a random-effects model. Frail patient mortality data was not reported for Yue et al. I2 = 0 and Q is not larger than Q (df), suggesting low heterogeneity [26,32]. (c) Meta-analysis on available data indicates that the mortality rate for non-frail patients with aSAH is 12.1% (CI 8.9–16.2%, p < 0.001) when using a random-effects model. Non-frail patient mortality data was not reported for Yue et al. I2 = 0 and Q is not larger than Q (df), suggesting low heterogeneity [26,32].
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