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Dicpinigaitis AJ, Kazim SF, Al-Mufti F, Hall DE, Reitz KE, Rumalla K, McIntyre MK, Arthur AS, Srinivasan VM, Burkhardt JK, Schmidt MH, Gandhi CD, Bowers CA. Frailty in aneurysmal subarachnoid hemorrhage: the risk analysis index. J Neurol 2023; 270:4820-4826. [PMID: 37329347 PMCID: PMC11096733 DOI: 10.1007/s00415-023-11805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Few studies have evaluated frailty in the setting of aneurysmal subarachnoid hemorrhage (aSAH) using large-scale data. The risk analysis index (RAI) may be implemented at the bedside or assessed retrospectively, differentiating it from other indices used in administrative registry-based research. METHODS Adult aSAH hospitalizations were identified in the National Inpatient Sample (NIS) from 2015 to 2019. Complex samples statistical methods were performed to evaluate the comparative effect size and discriminative ability of the RAI, the modified frailty index (mFI), and the Hospital Frailty Risk Score (HFRS). Poor functional outcome was determined by the NIS-SAH Outcome Measure (NIS-SOM), shown to have high concordance with modified Rankin Scale scores > 2. RESULTS 42,300 aSAH hospitalizations were identified in the NIS during the study period. By both ordinal [adjusted odds ratio (aOR) 3.20, 95% confidence interval (CI) 3.05, 3.36, p < 0.001] and categorical stratification [frail aOR 3.59, 95% CI 3.39, 3.80, p < 0.001; severely frail aOR 6.67, 95% CI 5.78, 7.69, p < 0.001], the RAI achieved the largest effect sizes for NIS-SOM in comparison with the mFI and HFRS. Discrimination of the RAI for NIS-SOM in high-grade aSAH was significantly greater than that of the HFRS (c-statistic 0.651 vs. 0.615). The mFI demonstrated the lowest discrimination in both high-grade and normal-grade patients. A combined Hunt and Hess-RAI model (c-statistic 0.837, 95% CI 0.828, 0.845) for NIS-SOM achieved significantly greater discrimination than both the combined models for mFI and HFRS (p < 0.001). CONCLUSION The RAI was robustly associated with poor functional outcomes in aSAH independent of established risk factors.
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Affiliation(s)
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA
| | - Fawaz Al-Mufti
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, 10595, USA
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Katherine E Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA
| | - Matthew K McIntyre
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Sciences Center/Semmes-Murphy Clinic, Memphis, TN, 38120, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA
| | - Chirag D Gandhi
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, 10595, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA.
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Koo AB, Elsamadicy AA, Renedo D, Matouk C. Response to letter to the Editor on 'Utility of the Hospital Frailty Risk Score in patients undergoing endovascular treatment for ruptured aneurysms'. J Neurointerv Surg 2023; 15:307-308. [PMID: 36319084 DOI: 10.1136/jnis-2022-019708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew B Koo
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniela Renedo
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
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