Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis*

Abstract

OBJECTIVES:Frailty is a multidimensional syndrome or state of increased vulnerability to poor resolution of homoeostasis following a stressor event. Frailty is common in patients with sepsis. Sepsis and frailty are both associated with older age and chronic medical conditions. However, there is limited evidence about the direct association between frailty and sepsis. The aim of this study is to determine the association between preexisting clinical frailty and clinical outcomes in patients with sepsis. DESIGN:A nationwide propensity score-matched cohort study analyzing data prospectively collected between September 2019 and February 2020. SETTING:Nineteen tertiary or university-affiliated hospitals in South Korea. PATIENTS:Adult patients who were diagnosed with sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Frailty status was assessed using the Clinical Frailty Scale. All patients were classified as "frail" (Clinical Frailty Scale score, 5-9) or "nonfrail" (Clinical Frailty Scale score, 1-4). Propensity score matching identified comparable nonfrail patients. The primary outcome was inhospital mortality. Multivariable logistic regression analysis was used to evaluate the association between frailty and inhospital mortality. The propensity scorematched cohort comprised 468 nonfrail patients and 468 frail patients; all covariate imbalances were alleviated. In the matched cohort (mean age, 69 ± 14 yr), 27.2% had septic shock at presentation. Inhospital mortality was 34.2% in the frail group and 26.9% in the nonfrail group (p = 0.019). The adjusted odds ratio for inhospital mortality in the frail group compared with the nonfrail group was 2.00 (95% CI, 1.39-2.89; p < 0.001). Among the patients who survived to discharge, the frail group was less likely to be discharged home compared with the nonfrail group, 64.0% versus 81.3%, respectively (p < 0.001). CONCLUSIONS:In patients with sepsis, preexisting clinical frailty is associated with worse clinical outcomes than that in nonfrail patients, including inhospital mortality and discharge to home.

Account of Deep Learning-Based Ultrasonic Image Feature in the Diagnosis of Severe Sepsis Complicated with Acute Kidney Injury

“…In addition, inflammation often interacts with coagulation dysfunction and then influences the development of sepsis. The decreased expression of tissue factors cannot initiate the exogenous coagulation pathway, which results in coagulation disorders and accelerates the formation of vascular damage [ 12 – 14 ].…”

How Should We Use Frailty Evaluation for Patients With Sepsis in the Clinical Practice?

“…Finally, the study by Lee et al (1) included patients across a wide age range. Although this could be considered a strength, there is an opinion that frailty is a concept born in geriatrics and that the Clinical Frailty Scale (CFS) score should be measured only in elderly individuals (5).…”

The authors reply

“…We appreciate the thoughtful letter by Matsuda and Yamamoto (1) regarding our article (2). Matsuda and Yamamoto (1) raise an important consideration regarding how to use frailty for evaluation of patients with sepsis in the clinical practice and suggest that preexisting clinical frailty may be a new indicator for use of broad-spectrum antibiotics in patients with sepsis.…”

“…The methodology of propensity score matching is presented in our article (2). Univariable and multivariable logistic regression analyses were used to evaluate the association between preexisting clinical frailty and MDR organisms.…”