Frailty is increasingly recognized as a predictor of poor outcomes in acute neurological conditions. However, its impact on the short-term prognosis of patients with intracranial hemorrhage (ICrH) remains unclear. This meta-analysis aimed to evaluate the association between frailty and short-term mortality and functional outcomes in patients with ICrH.

A systematic literature search was conducted in PubMed, Embase, and Web of Science from inception to February 10, 2025. Cohort studies evaluating the association between frailty and prognosis in ICrH patients were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model by incorporating the influence of heterogeneity.

Twelve cohort studies involving 70,664 patients with ICrH were included. Frailty was significantly associated with increased short-term mortality (OR: 1.79, 95% CI: 1.36–2.35, p <  0.001; I² = 72%) and poor functional outcome (OR: 1.75, 95% CI: 1.33–2.30, p <  0.001; I² = 67%). Subgroup analyses were performed for mortality outcomes and confirmed consistent associations across different patient demographics, frailty assessment tools, and follow-up durations (p for subgroup difference all > 0.05). Sensitivity analyses by excluding one study at a time showed similar results (p all < 0.05), which demonstrated robustness.

Our study suggests that frailty may be associated with an increased risk of short-term mortality and poor functional outcomes in patients with ICrH. These findings highlight the importance of frailty assessment in risk stratification and clinical decision-making for ICrH patients.