Frailty in Spontaneous Intracerebral Hemorrhage and Its Outcomes: A Systematic Review and Meta-Analysis.

Abstract

Frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have evaluated the association of frailty and spontaneous intracerebral hemorrhage (SICH) incidence and outcomes. The aim of this systematic review and meta-analysis was to investigate the odds of frailty in SICH and the prognosis of SICH patients who are frail. Following a the International Prospective Register of Systematic Reviews-registered protocol, 3 authors conducted a systematic review of the PubMed/Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases up to October 17, 2024. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. A standard pairwise meta-analysis using odds ratios (ORs) and 95% confidence intervals (CIs) was performed, with results presented in forest plots. From 8 included studies (17,524 participants), the odds of frailty are significantly higher in SICH patients than patients without SICH (OR: 1.47, 95% CI: 1.31 to 1.64, P < 0.01). Within the SICH cohort, frail patients have significantly higher rates of mortality (OR: 3.48, 95% CI: 2.51 to 4.82, P < 0.01) and unfavorable outcome (modified Rankin Scale 3-6) (OR: 1.75, 95% CI: 1.35 to 2.26, P < 0.01) CONCLUSIONS: SICH patients are more likely to be frail, and SICH patients who are frail have higher rates of mortality and adverse outcomes. Further research is required to compare the robustness of different frailty assessment tools in assessing frailty in SICH cohorts.