Introduction: Intracerebral hemorrhages (ICH) carry the highest rates of morbidity and mortality of the stroke subtypes. Many current grading scales such as the ICH score only take into account factors such as size of hemorrhage, neurologic exam, and age. They do not consider the patient's pre-hemorrhage medical comorbidities. One model of frailty suggests that there is decreased reserve in multiple organ systems due to accumulating deficits. The modified frailty index (mFI) consists of 11 items and has been shown to correlate with increased morbidity and mortality in multiple surgical subspecialties. This study aims to analyze whether there is a similar correlation between mFI and ICH mortality rates.
Methods: We performed a retrospective chart review of all patients admitted with intracerebral hemorrhage between September 2015 and September 2017. The electronic medical records were analyzed to identify mFI components, in-hospital mortality rates, and other standard ICH variables (e.g. hematoma size, neurologic outcomes, etc.).
Results: Our preliminary data on 54 of 209 overall patients shows that increasing frailty is associated with worse morbidity and mortality. 11.1% (6/54) had an mFI of 0, 16.7% (9/54) an mFI of 1, 22.2% (12/54) an mFI of 2, 20.4% (11/54) an MFI of 3, 22.2% (12/54) an mFI of 4, and 7.4% (4/54) an mFI of 5. When grouped into robust (mFI of 0), pre-frail (mFI 1-2), and frail (mFI =3), there was an association with increasing mortality rates. There was a mortality rate of 16.7% (1/6) in robust patients, 23.8% (5/21) in prefrail patients, and 37% in frail patients (10/27).
Conclusions: There are numerous scoring systems that predict morbidity and mortality after spontaneous intracerebral hemorrhages. However, these scoring schemas are influenced principally by the hemorrhage size and the presenting neurologic exam. They do not factor in the patient’s frailty or underlying medical comorbidities. The mFI adds another element that is useful in counseling spontaneous ICH patients by predicting their mortality rates based on their medical history.
Patient Care: This research aims to see how a patient's pre-hemorrhage medical comorbidities will influence their outcomes after a spontaneous intracerebral hemorrhage. Most current scoring systems only account for hemorrhage characteristics and the patient's presenting neurologic exam.
Learning Objectives: By the conclusion of this session, participants should able to:
1) Describe frailty and the components of the Modified Frailty Index
2) Describe how frailty influences outcomes in numerous medical specialties
3) Describe the impact frailty has on the outcomes of spontaneous hypertensive intracerebral hemorrhages.
References: 1. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-897. http://www.ncbi.nlm.nih.gov/pubmed/11283388.
2. Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: Its application to a national database. J Surg Res. 2013;183(1):104-110. doi:10.1016/j.jss.2013.01.021.