A comparison of frailty indices in predicting length of inpatient stay and discharge destination following angiogram-negative subarachnoid hemorrhage. (4th July 2021)

• Record Type: Journal Article
• Authors: McIntyre, Matthew K.; Gandhi, Chirag; Dragonette, James; Schmidt, Meic; Cole, Chad; Santarelli, Justin; Lehrer, Rachel; Al-Mufti, Fawaz; Bowers, Christian A.
• Is Part Of: British journal of neurosurgery. Volume 35:Number 4(2021)
• Page Start: 402
• Page End: 407
• Publication Date: 2021-07-04
• Subjects: Subarachnoid hemorrhage -- angiogram-negative subarachnoid hemorrhage -- modified frailty index -- Charlson Comorbidity index -- temporalis thickness; Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.1080/02688697.2020.1781056
• Languages: English
• ISSNs: 0268-8697

Abstract

Abstract: Background and Purpose: While patients with angiogram-negative subarachnoid hemorrhages (ANSAH) have better prognoses than those with aneurysmal SAH, frailty's impact on outcomes in ANSAH is unclear. We previously showed that the modified frailty index (mFI-11) is associated with poor outcomes following ANSAH. Here, we compared the mFI-5, mFI-11, Charlson Comorbidity Index (CCI), and temporalis thickness (TMT) to determine which index was the best predictor of ANSAH outcomes and mortality rates. Methods: In this retrospective cohort analysis between 2014 and 2018, patients with non-traumatic, angiogram negative SAH (ANSAH) were identified. The admission mFI-5, mFI-11, CCI, and TMT were calculated for each patient. Primary outcomes were mortality rate, discharge location, and prolonged length of stay (PLOS; LOS >85 th percentile). Multivariate logistic regression and receiver operating characteristic (ROC) curves were used to evaluate frailty as predictors of primary endpoints. Results: We included 75 patients with a mean age of 55.4 ± 1.5 years. There were 4 patient deaths (5.3%), 53 patients (70.7%) discharged home, and 11 patients (14.7%) with PLOS. On ROC analysis, the mFI-5 had the highest discriminatory value for mortality (AUC = 0.97) while the mFI-11 was most discriminatory for discharge home (AUC = 0.85) and PLOS (AUC = 0.78). On multivariate analysis, the only independent predictor of mortality was the mFI-11 (OR = 0.46; 95%CI: 1.45–14.23; p = 0.009) while the mFI-5 was the best predictor of discharge home (OR = 0.21; 95% CI: 0.08–0.61; p = 0.004). On multivariate analysis, the only independent predictor of PLOS was the Hunt and Hess score (OR = 2.63; 95%CI: 1.38–5.00; p = 0.003). The CCI and TMT were inferior to either mFI for predicting primary endpoints. Conclusions: Increasing frailty is associated with poorer outcomes and higher mortality following ANSAH. The mFI-5 and mFI-11 were found to be superior predictors of discharge home and mortality rate. While larger prospective study is needed, frailty, as measured by mFI-11 and -5, should be considered when evaluating ANSAH prognosis.