Frailty in Spontaneous Intracerebral Haemorrhage and its Outcomes: A Systematic Review and Meta-Analysis.

Background: 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 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.

Methods: Following a PROSPERO-registered protocol, three authors conducted a systematic review of the PubMed/Medline, Embase, Cochrane Library and CINAHL databases up to 17 October 2024. The certainty of evidence was assessed using the GRADE framework. A standard pairwise meta-analysis using odds ratios and 95% confidence intervals was performed, with results presented in forest plots.

Results: 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 unfavourable outcome (mRS 3-6) (OR: 1.75, 95% CI: 1.35 to 2.26, p < 0.01) CONCLUSION: 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.