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Pre-existing frailty strongly predicted poor recovery at 6 months after nonaneurysmal subarachnoid hemorrhage.  

Researchers conducted a retrospective study published in July 2025 issue of Journal of Neurology to examine the link between pre-existing frailty and functional outcomes in individuals with spontaneous, nonaneurysmal subarachnoid hemorrhage (naSAH) who exhibited a normal cerebral angiogram during evaluation of the bleeding source. 

They included 257 individuals treated for spontaneous naSAH at 2 neurovascular centers from 2012 to 2021. Pre-existing frailty was determined using the modified frailty index (mFI), categorizing individuals as nonfrail (mFI 0–1) or frail (mFI ≥ 2). Functional status at 6 months was assessed using the modified Rankin Scale (mRS), with outcomes grouped as favorable (mRS 0–2) or unfavorable (mRS 3–6). They applied multivariable logistic regression analysis to identify factors independently linked to unfavorable outcomes.  

The results showed that among 257 individuals with naSAH, 56 (22%) were identified as frail (mFI ≥ 2) prior to ictus. At 6 months, unfavorable functional outcomes occurred in 17 of the 56 frail individuals (30%) and in 21 of the 201 nonfrail individuals (10%) [P= 0.001]. Multivariable analysis confirmed that frailty [P= 0.03], delayed cerebral ischemia (DCI) [P< 0.001], and poor-grade naSAH [Hunt & Hess grades III–IV; P= 0.001] were independently associated with increased risk of unfavorable outcomes.  

Investigators concluded that pre-existing frailty, defined by a mFI of ≥ 2, was significantly linked to poorer 6-month functional outcomes in individuals with naSAH. 

Source: link.springer.com/article/10.1007/s00415-025-13227-5