Frailty and Early Mortality following Intracerebral Hemorrhage.

Introduction: Prognostication in spontaneous intracerebral hemorrhage (ICH) is vital for effective clinical decision-making but can be challenging. Frailty - the loss of physiological reserve to withstand stressor events - is a risk factor for poor outcomes after ischemic stroke, yet its role in ICH remains poorly understood. This study investigates whether frailty is independently associated with 28-day mortality following ICH.

Methods: A validated pre-stroke frailty index (FI) was measured for individuals presenting with ICH, yielding a FI of 0-1. The relationship between 28-day mortality and FI was assessed using multivariable logistic regression adjusting for age, neurosurgical intervention, National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Score (GCS), and ICH volume.

Results: Forty (34.5%) of 116 individuals with ICH died within 28 days. Frailty was independently associated with 28-day mortality, with each 0.1 increase in FI independently associated with an adjusted odds ratio of death of 1.09 (95% CI: 1.01-1.18). ICH volume was also independently associated with mortality (aOR 1.04, 95% CI: 1.02-1.06 per 10 mL increase). In contrast, age and neurosurgical intervention were not independently associated with mortality in our cohort.

Conclusion: Higher pre-stroke frailty is independently associated with early mortality following spontaneous ICH, indicating the potential of frailty evaluation to inform prognostication and clinical decision-making.