The Impact of Frailty on Functional Outcome in Neurointensive Care Patients

Abstract

Background: Frailty, defined as an age-related syndrome of multidimensional physiological decline, may serve as a valuable marker to identify brain-injured patients who are less likely to benefit from aggressive treatment, thus avoiding unnecessary interventions. Here we aimed to evaluate the predictive value of the Clinical Frailty Scale (CFS) score for functional outcome. Methods: This retrospective study included 1008 patients admitted to the neurological intensive care unit (ICU), with ischemic and hemorrhagic stroke (subarachnoid hemorrhage, SAH and intracerebral hemorrhage, ICH), and traumatic brain injury (TBI). Outcome was evaluated with the modified Rankin Scale (mRS) at ICU discharge. Correlations and univariate analyses identified factors linked to higher CFS levels, while multivariable logistic regression evaluated CFS's potential to predict poor outcome (mRS ≥ 4). Results: Patients were admitted with ischemic stroke (n = 256, 25%), hemorrhagic stroke (n = 516, 51%) or TBI (n = 236, 23%) and the mean age was 66 years (IQR, 54–77). All disease severity grades were included, with a median GCS of 14 (9–15) at admission. The median premorbid CFS was 2 (1–3) with 9.2% of patients classified as frail (CFS ≥ 5). In multivariable analysis, CFS ≥ 5 was independently associated with poor outcome (adjOR [95% CI] 2.83 [1.50–5.33], p = 0.001). In a subgroup of patients aged ≥ 65 years (n = 532, 53%), a CFS-score of ≥ 5 was associated with poor outcome (adjOR [95% CI] 2.51 [1.24–5.09], p = 0.011), whereas age itself was not associated with poor outcome (p = 0.095). Conclusions: Frailty as measured by the CFS remained a significant predictor of outcome, whereas age alone was not associated with poor outcome in patients aged ≥ 65 years.