Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Lenneke E M Haas; Ariane Boumendil; Hans Flaatten; Bertrand Guidet; Mercedes Ibarz; Christian Jung; Rui Moreno; Alessandro Morandi; Finn H Andersen; Tilemachos Zafeiridis; Sten Walther; Sandra Oeyen; Susannah Leaver; Ximena Watson; Carole Boulanger; Wojciech Szczeklik; Joerg C Schefold; Maurizio Cecconi; Brian Marsh; Michael Joannidis; Yuriy Nalapko; Muhammed Elhadi; Jesper Fjølner; Antonio Artigas; Dylan W de Lange

doi:10.1093/ageing/afab036

Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Lenneke E M Haas, Ariane Boumendil, Hans Flaatten, Bertrand Guidet, Mercedes Ibarz, Christian Jung, Rui Moreno, Alessandro Morandi, Finn H Andersen, Tilemachos Zafeiridis, Sten Walther, Sandra Oeyen, Susannah Leaver, Ximena Watson, Carole Boulanger, Wojciech Szczeklik, Joerg C Schefold, Maurizio Cecconi, Brian Marsh, Michael JoannidisYuriy Nalapko, Muhammed Elhadi, Jesper Fjølner, Antonio Artigas, Dylan W de Lange

NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

Abstract

BACKGROUND: Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.

OBJECTIVE: To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.

DESIGN: Prospective cohort study.

SETTING: 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.

SUBJECTS: Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.

METHODS: Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.

RESULTS: Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).

CONCLUSIONS: There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

Original language	English
Pages (from-to)	1719-1727
Journal	Age And Ageing
Volume	50
Issue number	5
Early online date	20 Mar 2021
DOIs	https://doi.org/10.1093/ageing/afab036
Publication status	Published - 11 Sept 2021

Keywords

frailty
intensive care unit (ICU)
mortality
sepsis
very old people

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Haas, L. E. M., Boumendil, A., Flaatten, H., Guidet, B., Ibarz, M., Jung, C., Moreno, R., Morandi, A., Andersen, F. H., Zafeiridis, T., Walther, S., Oeyen, S., Leaver, S., Watson, X., Boulanger, C., Szczeklik, W., Schefold, J. C., Cecconi, M., Marsh, B., ... de Lange, D. W. (2021). Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age And Ageing, 50(5), 1719-1727. https://doi.org/10.1093/ageing/afab036

@article{dbb2403fde184364bd5dd02e76c1d1fd,

title = "Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs",

abstract = "BACKGROUND: Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.OBJECTIVE: To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.DESIGN: Prospective cohort study.SETTING: 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.SUBJECTS: Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.METHODS: Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.RESULTS: Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).CONCLUSIONS: There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.",

keywords = "frailty, intensive care unit (ICU), mortality, sepsis, very old people",

author = "Haas, {Lenneke E M} and Ariane Boumendil and Hans Flaatten and Bertrand Guidet and Mercedes Ibarz and Christian Jung and Rui Moreno and Alessandro Morandi and Andersen, {Finn H} and Tilemachos Zafeiridis and Sten Walther and Sandra Oeyen and Susannah Leaver and Ximena Watson and Carole Boulanger and Wojciech Szczeklik and Schefold, {Joerg C} and Maurizio Cecconi and Brian Marsh and Michael Joannidis and Yuriy Nalapko and Muhammed Elhadi and Jesper Fj{\o}lner and Antonio Artigas and {de Lange}, {Dylan W}",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. ",

year = "2021",

month = sep,

day = "11",

doi = "10.1093/ageing/afab036",

language = "English",

volume = "50",

pages = "1719--1727",

journal = "Age And Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "5",

}

Haas, LEM, Boumendil, A, Flaatten, H, Guidet, B, Ibarz, M, Jung, C, Moreno, R, Morandi, A, Andersen, FH, Zafeiridis, T, Walther, S, Oeyen, S, Leaver, S, Watson, X, Boulanger, C, Szczeklik, W, Schefold, JC, Cecconi, M, Marsh, B, Joannidis, M, Nalapko, Y, Elhadi, M, Fjølner, J, Artigas, A & de Lange, DW 2021, 'Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs', Age And Ageing, vol. 50, no. 5, pp. 1719-1727. https://doi.org/10.1093/ageing/afab036

TY - JOUR

T1 - Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old

T2 - results from an observational study in 241 European ICUs

AU - Haas, Lenneke E M

AU - Boumendil, Ariane

AU - Flaatten, Hans

AU - Guidet, Bertrand

AU - Ibarz, Mercedes

AU - Jung, Christian

AU - Moreno, Rui

AU - Morandi, Alessandro

AU - Andersen, Finn H

AU - Zafeiridis, Tilemachos

AU - Walther, Sten

AU - Oeyen, Sandra

AU - Leaver, Susannah

AU - Watson, Ximena

AU - Boulanger, Carole

AU - Szczeklik, Wojciech

AU - Schefold, Joerg C

AU - Cecconi, Maurizio

AU - Marsh, Brian

AU - Joannidis, Michael

AU - Nalapko, Yuriy

AU - Elhadi, Muhammed

AU - Fjølner, Jesper

AU - Artigas, Antonio

AU - de Lange, Dylan W

PY - 2021/9/11

Y1 - 2021/9/11

N2 - BACKGROUND: Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.OBJECTIVE: To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.DESIGN: Prospective cohort study.SETTING: 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.SUBJECTS: Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.METHODS: Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.RESULTS: Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).CONCLUSIONS: There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

AB - BACKGROUND: Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.OBJECTIVE: To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.DESIGN: Prospective cohort study.SETTING: 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.SUBJECTS: Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.METHODS: Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.RESULTS: Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).CONCLUSIONS: There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

KW - frailty

KW - intensive care unit (ICU)

KW - mortality

KW - sepsis

KW - very old people

U2 - 10.1093/ageing/afab036

DO - 10.1093/ageing/afab036

M3 - Article

C2 - 33744918

SN - 0002-0729

VL - 50

SP - 1719

EP - 1727

JO - Age And Ageing

JF - Age And Ageing

IS - 5

ER -

Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Abstract

Keywords

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