Abstract
OBJECTIVE: The relationship between pre-stroke frailty and clinical outcomes remains unclear. This systematic review aimed to examine the association of pre-stroke frailty with mortality, length of stay (LOS), and functional outcomes in people with stroke. METHODS: We used several databases, including PubMed, EMBASE, and CENTRAL. We searched for studies investigating the association between pre-stroke frailty and clinical outcomes. The Quality in Prognosis Studies tool was used to assess the risk of bias in the included studies. Meta-analyses were performed using the random effects model. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: Fourteen studies (participants: 11583) were included in this review. Pre-stroke frailty is associated with higher mortality (odds ratio: 1.11; 95% confidence intervals [CI]: 1.0-1.23), longer LOS (mean difference: 0.75; 95% CI: -0.29 to 1.78), and poorer functional outcomes (standardized mean difference: 0.79; 95% CI: 0.48-1.1). The certainty of evidence is low due to risk of bias, inconsistency, and imprecision. CONCLUSIONS: These results suggest that frailty before stroke onset may be associated with higher mortality, increased LOS, and poorer functional outcomes.