NYMC Faculty Publications

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

Michael Fortunato, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Fangyi Lin, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Anaz Uddin, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Galadu Subah, Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Rohan Patel, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Eric Feldstein, Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Aiden Lui, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Jose Dominguez, Brain and Spine Institute, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Matthew Merckling, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Patricia Xu, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Matthew McIntyre, Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Chirag Gandhi, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.Follow
Fawaz Al-Mufti, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.Follow

Author Type(s)

Student, Resident/Fellow, Faculty

DOI

10.3390/brainsci13101498

Journal Title

Brain Sciences

Document Type

Article

Publication Date

10-23-2023

Department

Neurology

Second Department

Neurosurgery

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 ( < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model ( < 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.

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