Frailty and hospital outcomes among patients with neurological disorders

INTRODUCTION: Patients with neurological disorders, particularly those who are chronologically and biologically older, may display highly varied clinical courses and trajectories. The present study explored the association between frailty and hospital outcomes among patients with acute neurological presentations admitted to an Italian university hospital. MATERIALS AND METHODS: A cross-sectional study considered all patients consecutively admitted to the Neurology Unit of the Policlinico Umberto I University Hospital of Rome (Italy). A 40-item Frailty Index (FI) was retrospectively developed based on the clinical information collected in the Emergency Department (ED). Data on hospitalization outcomes were prospectively collected during the patient's stay at the Neurology Unit. Linear and logistic regression models were conducted to test the association between FI and hospital outcomes. RESULTS: Overall, 185 participants (women 50.3%; mean age 68.6, SD 18.6 years) were included. FI scores ranged between 0 and 0.43, with a median value of 0.15 [IQR 0.10], and were positively correlated with age (Spearman's rho 0.55, p < 0.001). In a linear regression model adjusted by age, sex, and diagnosis, FI was significantly associated with the number of days spent in the Neurology Unit (B 2.18, 95%CI 0.25-4.11, per 0.1 increase; p = 0.03). In bivariate logistic regression models adjusted by age, sex, and diagnosis, increasing FI scores were significantly associated with a lower likelihood of being discharged at home (OR 0.37, 95%CI 0.20-0.63, per 0.1 increase; p < 0.001), with higher odds of nosocomial infections (OR 1.67, 95%CI 1.05-2.73 per 0.1 increase; p = 0.03), and prescription of antibiotics (OR 1.77, 95%CI 1.11-2.92, per 0.1 increase; p = 0.02). CONCLUSION: Frailty is adversely associated with hospital outcomes in patients with acute neurological disorders. Assessing frailty could improve patient stratification, prognostication, and care planning, with a relevant impact on healthcare resources.