• Matthew K McIntyre, Chirag Gandhi, Andrew Long, Alexander Van Hoof, Boyi Li, Vikas Patel, Adil Afridi, Mohamed Halabi, Meic Schmidt, Chad Cole, Justin Santarelli, Fawaz Al-Mufti, and Christian A Bowers.
• School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
• Clin Neurol Neurosurg. 2019 Dec 1; 187: 105558.

ObjectiveIncreasing age has been associated with worse outcomes following aneurysmal subarachnoid hemorrhage (aSAH), yet frailty's effect on aSAH outcomes has never been studied. The most common frailty measurement tool is the modified frailty index (mFI). The goal of this study is to compare the effect of frailty versus age as predictors of aSAH outcomes and mortality.Patients And MethodsOur institutional aSAH series were retrospectively identified and divided into non-frail (mFI = 0-1) and frail (mFI≥2) cohorts based on admission mFI scores. Primary outcomes were mortality and discharge location. Univariate and multivariate analysis were performed.ResultsThere were 217 aSAH patients identified and 57 were frail (26.3%). Forty-one (18.9%) patients died and 74 (34%) were discharged home. Frail patients were significantly older (p < 0.0001) and had higher Hunt & Hess (HH) (p = 0.005) and Fisher (p = 0.0255) scores. Frail patients were less likely to receive an intervention (OR = 0.3; 95%CI:0.1-0.6); p = 0.0056), be discharged home (OR = 0.32; 95%CI:0.16-0.68; P = 0.0020), and were more likely to expire (OR = 2.4; 95%CI:1.2-5; P = 0.0183) and develop a complication (OR = 2.6; 95%CI:1.1-6.6; P = 0.0277). Multivariate regressions showed that the HH score (OR = 2.7; 95%CI: 1.9-3.0; P < 0.0001) followed by age≥65 (OR = 2.7; 95%CI:1.2-6.0; p = 0.012) were the only independent predictors of mortality. Likewise, discharge home was best predicted by HH score (OR = 0.24; 95%CI:0.15-0.37; p < 0.0001) and age (OR = 0.25; 95%CI:0.1-0.6; p = 0.003).ConclusionFrailty is associated with worse aSAH grades, more complications, and increased mortality, however, increasing age and HH scores were the only independent predictors of aSAH outcomes. This study suggests that HH score and increasing patient age, and not the accumulated co-morbidities at the time of aSAH, better predict outcomes.Copyright © 2019 Elsevier B.V. All rights reserved.

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