Increasing Frailty Predicts Worse Outcomes and Increased Complications Following Angiogram-Negative Subarachnoid Hemorrhages
BACKGROUND: The effect of frailty on outcomes following Angiogram-negative subarachnoid hemorrhages (ANSAH) is currently unknown. We investigated frailty's effects on ANSAH outcomes, including mortality and in-hospital complications. METHODS: Patients with non-traumatic SAH and cerebral angiograms with an unidentifiable hemorrhage source were retrospectively reviewed from 2014 to 2018. The cohort was divided into non-frail (modified frailty index [mFI] of 0) and frail (mFI>/=1) groups based on pre-hemorrhage characteristics. Primary outcomes were mortality rate and discharge location. Multivariate logistic regression analyses determined predictors of ANSAH severity and primary endpoints. Receiver operating characteristic (ROC) curves used to discriminate risks for primary endpoints comparing mFI, Hunt&Hess and Fisher scores, and age. RESULTS: We included 75 patients with a mean age of 55.4+/-1.5 years, comprised of 42 (56%) females, and 41 (54.7%) with perimesencephalic bleeds. A total of 32/75 (42.7%) patients were classified as frail. Frail individuals were 6.2 times less likely to be discharged home (OR=0.16; 95%CI: 0.05-0.5; p=0.0009) and all mortalities occurred in frail patients (12.5% [n=4/32]; p=0.0296). The only independent predictor of mortality was higher mFI (OR=5.4;95%CI: 1.5-19.1; p=0.009), while lower mFI best predicted discharge home (OR=0.39; 95%CI: 0.17-0.88; p=0.023). ROC analysis showed that mFI best predicted both mortality (AUC=0.9718; p=0.0016) and discharge home (AUC=0.7998; p<0.0001). CONCLUSIONS: Frail ANSAH patients have poorer outcomes and increased mortality compared to non-frail patients. While prospective study is needed, this information significantly impacts our understanding of ANSAH outcomes and frailty should be used for prognostication as it was a better predictor than Hunt/Hess or Fisher Scores.