Background: Frailty is an established predictor of poor outcomes in perioperative and acute medicine, however comparison between frailty indices in intracerebral haemorrhage (ICH) remains understudied. This study evaluates the independent predictive value of the Clinical Frailty Score (CFS) and Modified Frailty Index (mFI) for mortality and functional recovery in ICH patients.
Methods: This retrospective observational study consecutively enrolled patients with ICH admitted to our institute between Jan 2019 to Dec 2023. Mortality was measured at 6 months. Functional outcome was measured using Modified Rankin Scale (mRS) scores on discharge, categorised into good (0-2) or poor (>2). CFS and mFI scores were categorised into not frail (CFS=1-3, mFI=0), mild-moderate frailty (CFS=4-6. MFI=1-2), and severe frailty (CFS=7-8, MFI≥3). Multivariate regression was used for both outcomes with premorbid mRS being an additional covariate for functional outcome analysis.
Results: The study included 584 patients (49.0% male) with a median age of 78.9 years (IQR 68.7–86.0). 221 (37.84%) died during, or within 6 months of admission. Of those who survived, 233 (64.19%) had a poor functional outcome. Both CFS and mFI were independent predictors for mortality and poor functional outcome. For mortality, mFI (OR 3.34; 95%CI:1.51-7.39; P=0.003) demonstrated stronger association compared to CFS (OR 2.49; 95%CI:1.31-4.74; P=0.006). For poor functional outcome, CFS (OR 48.06; 95%CI: 3.877-595.78; P=0.003) demonstrated a very strong association compared to mFI (OR 2.74; 95%CI: 1.17-6.45; P=0.021).
Conclusion: In patients with ICH, CFS demonstrates a greater predictive strength for poor functional outcome compared to mFI but is weaker in predicting mortality.