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.

1.
Clegg
A
,
Young
J
,
Iliffe
S
,
Rikkert
MO
,
Rockwood
K
.
Frailty in elderly people
.
Lancet
.
2013
;
381
(
9868
):
752
62
.
2.
Wallis
SJ
,
Wall
J
,
Biram
RW
,
Romero-Ortuno
R
.
Association of the clinical frailty scale with hospital outcomes
.
QJM
.
2015
;
108
(
12
):
943
9
.
3.
Evans
NR
,
Todd
OM
,
Minhas
JS
,
Fearon
P
,
Harston
GW
,
Mant
J
, et al
.
Frailty and cerebrovascular disease: concepts and clinical implications for stroke medicine
.
Int J Stroke
.
2022
;
17
(
3
):
251
9
.
4.
Evans
NR
,
Wall
J
,
To
B
,
Wallis
SJ
,
Romero-Ortuno
R
,
Warburton
EA
.
Clinical frailty independently predicts early mortality after ischaemic stroke
.
Age Ageing
.
2020
;
49
(
4
):
588
91
.
5.
Joyce
N
,
Atkinson
T
,
Mc Guire
K
,
Wiggam
MI
,
Gordon
PL
,
Kerr
EL
, et al
.
Frailty and stroke thrombectomy outcomes-an observational cohort study
.
Age Ageing
.
2022
;
51
(
2
):
afab260
.
6.
Kim
MG
,
Gandhi
C
,
Azizkhanian
I
,
Epstein
B
,
Mittal
A
,
Lee
N
, et al
.
Frailty and spontaneous intracerebral hemorrhage: does the modified frailty index predict mortality
.
Clin Neurol Neurosurg
.
2020
;
194
:
105816
.
7.
Imaoka
Y
,
Kawano
T
,
Hashiguchi
A
,
Fujimoto
K
,
Yamamoto
K
,
Nishi
T
, et al
.
Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage
.
Clin Neurol Neurosurg
.
2018
;
175
:
137
43
.
8.
Taylor-Rowan
M
,
Cuthbertson
G
,
Keir
R
,
Shaw
R
,
Drozdowska
B
,
Elliott
E
, et al
.
The prevalence of frailty among acute stroke patients, and evaluation of method of assessment
.
Clin Rehabil
.
2019
;
33
(
10
):
1688
96
.
9.
Theou
O
,
Haviva
C
,
Wallace
L
,
Searle
SD
,
Rockwood
K
.
How to construct a frailty index from an existing dataset in 10 steps
.
Age Ageing
.
2023
;
52
(
12
):
afad221
.
10.
Hanlon
P
,
Welsh
SA
,
Evans
NR
.
Constructing a quality frailty index: you get out what you put in
.
Age Ageing
.
2024
;
53
(
1
):
afad248
.
11.
Kwak
R
,
Kadoya
S
,
Suzuki
T
.
Factors affecting the prognosis in thalamic hemorrhage
.
Stroke
.
1983
;
14
(
4
):
493
500
.
12.
Kothari
RU
,
Brott
T
,
Broderick
JP
,
Barsan
WG
,
Sauerbeck
LR
,
Zuccarello
M
, et al
.
The ABCs of measuring intracerebral hemorrhage volumes
.
Stroke
.
1996
;
27
(
8
):
1304
5
.
13.
Pinho
J
,
Küppers
C
,
Nikoubashman
O
,
Wiesmann
M
,
Schulz
JB
,
Reich
A
, et al
.
Frailty is an outcome predictor in patients with acute ischemic stroke receiving endovascular treatment
.
Age Ageing
.
2021
;
50
(
5
):
1785
91
.
14.
Schnieder
M
,
Bähr
M
,
Kirsch
M
,
Maier
I
,
Behme
D
,
Riedel
CH
, et al
.
Analysis of frailty in geriatric patients as a prognostic factor in endovascular treated patients with large vessel occlusion strokes
.
J Clin Med
.
2021
;
10
(
10
):
2171
.
15.
Abulhasan
YB
,
Teitelbaum
J
,
Al-Ramadhani
K
,
Morrison
KT
,
Angle
MR
.
Functional outcomes and mortality in patients with intracerebral hemorrhage after intensive medical and surgical support
.
Neurology
.
2023
;
100
(
19
):
e1985
95
.
16.
Banerjee
G
,
Ambler
G
,
Wilson
D
,
Hostettler
IC
,
Shakeshaft
C
,
Lunawat
S
, et al
.
Baseline factors associated with early and late death in intracerebral haemorrhage survivors
.
Eur J Neurol
.
2020
;
27
(
7
):
1257
63
.
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