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
Authors: Haas Lenneke E M , Boumendil Ariane , Flaatten Hans , Guidet Bertrand , Ibarz Mercedes , Jung Christian , Moreno Rui , Morandi Alessandro , Andersen Finn H , Zafeiridis Tilemachos , Walther Sten , Oeyen Sandra , Leaver Susannah , Watson Ximena , Boulanger Carole , Szczeklik Wojciech , Schefold Joerg C , Cecconi Maurizio , Marsh Brian , Joannidis Michael , Nalapko Yuriy , Elhadi Muhammed , Fjølner Jesper , Artigas Antonio , de Lange Dylan W ,   VIP2 study group, Joannidis Michael , Eller Philipp , Helbok Raimund , Schmutz René , Nollet Joke , de Neve Nikolaas , De Buysscher Pieter , Oeyen Sandra , Swinnen Walter , Mikačić Marijana , Bastiansen Anders , Husted Andreas , Dahle Bård E S , Cramer Christine , Sølling Christoffer , Ørsnes Dorthe , Thomsen Jakob Edelberg , Pedersen Jonas Juul , Enevoldsen Mathilde Hummelmose , Elkmann Thomas , Kubisz-Pudelko Agnieszka , Pope Alan , Collins Amy , Raj Ashok S , Boulanger Carole , Frey Christian , Hart Ciaran , Bolger Clare , Spray Dominic , Randell Georgina , Filipe Helder , Welters Ingeborg D , Grecu Irina , Evans Jane , Cupitt Jason , Lord Jenny , Henning Jeremy , Jones Joanne , Ball Jonathan , North Julie , Salaunkey Kiran , De Gordoa Laura Ortiz-Ruiz , Bell Louise , Balasubramaniam Madhu , Vizcaychipi Marcela , Faulkner Maria , Mupudzi McDonald , Lea-Hagerty Megan , Reay Michael , Spivey Michael , Love Nicholas , Spittle Nick Spittle Nick , White Nigel , Williams Patricia , Morgan Patrick , Wakefield Phillipa , Savine Rachel , Jacob Reni , Innes Richard , Kapoor Ritoo , Humphreys Sally , Rose Steve , Dowling Susan , Leaver Susannah , Mane Tarkeshwari , Lawton Tom , Ogbeide Vongayi , Khaliq Waqas , Baird Yolanda , Romen Antoine , Galbois Arnaud , Guidet Bertrand , Vinsonneau Christophe , Charron Cyril , Thevenin Didier , Guerot Emmanuel , Besch Guillaume , Savary Guillaume , Mentec Hervé , Chagnon Jean-Luc , Rigaud Jean-Philippe , Quenot Jean-Pierre , Castaneray Jeremy , Rosman Jérémy , Maizel Julien , Tiercelet Kelly , Vettoretti Lucie , Hovaere Maud Mousset , Messika Messika , Djibré Michel , Rolin Nathalie , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Rabe Christian , Barth Eberhard , Ebelt Henning , Fuest Kristina , Franz Marcus , Horacek Michael , Schuster Michael , Meybohm Patrick , Bruno Raphael Romano , Allgäuer Sebastian , Dubler Simon , Schaller Stefan J , Schering Stefan , Steiner Stephan , Dieck Thorben , Rahmel Tim , Graf Tobias , Koutsikou Anastasia , Vakalos Aristeidis , Raitsiou Bogdan , Flioni Elli Niki , Neou Evangelia , Tsimpoukas Fotios , Papathanakos Georgios , Marinakis Giorgos , Koutsodimitropoulos Ioannis , Aikaterini Kounougeri , Rovina Nikoletta , Kourelea Stylliani , Polychronis Tasioudis , Zidianakis Vasiiios , Konstantinia Vryza , Aidoni Zoi , Marsh Brian , Motherway Catherine , Read Chris , Martin-Loeches Ignacio , Cracchiolo Andrea Neville , Morigi Aristide , Calamai Italo , Brusa Stefania , Elhadi Ahmed , Tarek Ahmed , Khaled Ala , Ahmed Hazem , Belkhair Wesal Ali , Cornet Alexander D , Gommers Diederik , de Lange Dylan , van Boven Eva , Haringman Jasper , Haas Lenneke , van den Berg Lettie , Hoiting Oscar , de Jager Peter , Gerritsen Rik T , Dormans Tom , Dieperink Willem , Breidablik Alena Breidablik Alena , Slapgard Anita , Rime Anne-Karin , Jannestad Bente , Sjøbøe Britt , Rice Eva , Andersen Finn H , Strietzel Hans Frank , Jensen Jan Peter , Langørgen Jørund , Tøien Kirsti , Strand Kristian , Hahn Michael , Klepstad Pål , Biernacka Aleksandra , Kluzik Anna , Kudlinski Bartosz , Maciejewski Dariusz , Studzińska Dorota , Hymczak Hubert , Stefaniak Jan , Solek-Pastuszka Joanna , Zorska Joanna , Cwyl Katarzyna , Krzych Lukasz J , Zukowski Maciej , Lipińska-Gediga Małgorzata , Pietruszko Marek , Piechota Mariusz , Serwa Marta , Czuczwar Miroslaw , Ziętkiewicz Mirosław , Kozera Natalia , Nasiłowski Paweł , Sendur Paweł , Zatorski Paweł , Galkin Piotr , Gawda Ryszard , Kościuczuk Urszula , Cyrankiewicz Waldemar , Gola Wojciech , Pinto Alexandre Fernandes , Fernandes Ana Margarida , Santos Ana Rita , Sousa Cristina , Barros Inês , Ferreira Isabel Amorim , Blanco Jacobo Bacariza , Carvalho João Teles , Maia Jose , Candeias Nuno , Catorze Nuno , Belskiy Vladislav , Lores Africa , Mira Angela Prado , Cilloniz Catia , Perez-Torres David , Maseda Emilio , Rodriguez Enver , Prol-Silva Estefania , Eixarch Gaspar , Gomà Gemma , Aguilar Gerardo , Velasco Gonzalo Navarro , Jaimes Marián Irazábal , Villamayor Mercedes Ibarz , Fernández Noemí Llamas , Cubero Patricia Jimeno , López-Cuenca Sonia , Tomasa Teresa , Sjöqvist Anders , Brorsson Camilla , Schiöler Fredrik , Westberg Henrik , Nauska Jessica , Sivik Joakim , Berkius Johan , Thiringer Karin Kleiven , De Geer Lina , Walther Sten , Boroli Filippo , Schefold Joerg C , Hergafi Leila , Eckert Philippe , Yıldız Ismail , Yovenko Ihor , Nalapko Yuriy , Nalapko Yuriy , Pugh Richard 
Published: February 2021

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 &lt; 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14–1.17, P &lt; 0.0001) and frailty (CFS &gt; 4): HR, 1.34 (95% CI, 1.18–1.51, P &lt; 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.