Penner Larissa, Potthoff Anna-Laura, Lampmann Tim, Heinz Rebecca, Lemcke Johannes, Hamed Motaz, Gessler Florian, Vatter Hartmut, Schuss Patrick, Hadjiathanasiou Alexis, Schneider Matthias
Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Bonn, Germany.
Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
J Neurol. 2025 Jul 2;272(8):488. doi: 10.1007/s00415-025-13227-5.
Frailty is increasingly recognized as a significant prognostic factor in various conditions. However, its impact on outcomes following spontaneous, nonaneurysmal subarachnoid hemorrhage (naSAH) remains unclear. This study aimed to assess the association between pre-existing frailty and functional outcomes in patients with naSAH.
The study cohort was made up of 257 patients treated for naSAH at two neurovascular centers between 2012 and 2021. Frailty prior to naSAH was assessed using the modified frailty index (mFI), with patients classified as nonfrail (mFI 0-1) or frail (mFI ≥ 2). Functional outcomes at 6 months were evaluated using the modified Rankin Scale (mRS), categorized as favorable (mRS 0-2) or unfavorable (mRS 3-6). A multivariable logistic regression analysis was performed to identify independent predictors of unfavorable outcomes.
Among 257 naSAH patients, 56 (22%) were classified as frail (mFI ≥ 2) before ictus. At the 6-month follow-up, unfavorable outcomes were observed in 17 of the 56 frail patients (30%) compared to 21 of 201 nonfrail patients (10%) (p = 0.001). In addition to established negative prognostic factors such as delayed cerebral ischemia (p < 0.001) and poor-grade naSAH (Hunt & Hess grades III-IV; p = 0.001), multivariable analysis identified frailty (p = 0.03) as an independent and significant predictor of unfavorable functional outcomes.
Frailty prior to hemorrhage, as determined by an mFI of ≥ 2, was associated with poor functional outcomes at 6 months in patients with naSAH. These findings underscore the importance of incorporating frailty assessments into early prognostic evaluations to guide patient management and counseling.
衰弱日益被认为是各种疾病中的一个重要预后因素。然而，其对自发性非动脉瘤性蛛网膜下腔出血（naSAH）后结局的影响仍不明确。本研究旨在评估naSAH患者预先存在的衰弱与功能结局之间的关联。
研究队列由2012年至2021年间在两个神经血管中心接受naSAH治疗的257例患者组成。使用改良衰弱指数（mFI）评估naSAH前的衰弱情况，患者分为非衰弱（mFI 0 - 1）或衰弱（mFI≥2）。使用改良Rankin量表（mRS）评估6个月时的功能结局，分为良好（mRS 0 - 2）或不良（mRS 3 - 6）。进行多变量逻辑回归分析以确定不良结局的独立预测因素。
在257例naSAH患者中，56例（22%）在发病前被分类为衰弱（mFI≥2）。在6个月的随访中，56例衰弱患者中有17例（30%）观察到不良结局，而201例非衰弱患者中有21例（10%）（p = 0.001）。除了既定的负面预后因素如延迟性脑缺血（p < 0.001）和低分级naSAH（Hunt & Hess分级III - IV；p = 0.001）外，多变量分析确定衰弱（p = 0.03）是不良功能结局的独立且重要的预测因素。
通过mFI≥2确定的出血前衰弱与naSAH患者6个月时的不良功能结局相关。这些发现强调了将衰弱评估纳入早期预后评估以指导患者管理和咨询的重要性。
