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Postintensive Care Frailty of Older Patients With Septic Shock: A Post Hoc Analysis of a Multicenter Randomized
Ryo Yamamoto1, Takahiro Yamanaka1, Daiki Kaito1
1Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
Objectives:
Postintensive care frailty impairs quality of life in survivors of severe illness. While anabolic hormone deficiency and prolonged inflammation are considered key physiologic mechanisms, specific features associated with frailty progression remain unclear. This study aimed to elucidate clinical characteristics associated with frailty deterioration following recovery from septic shock in older adults.
Design:
Post hoc analysis of a randomized controlled trial.
Setting:
ICUs in Japan.
Patients:
Adults of 65 years or older with septic shock.
Measurements And Main Results:
Data were analyzed from a randomized controlled trial investigating optimal blood pressure targets in patients of 65 years or older with septic shock. Frailty at 90 days after intensive care was classified as no-to-mild, moderate, and severe based on the Clinical Frailty Scale (CFS) scores of less than or equal to 4, 5-6, and greater than or equal to 7, respectively. Baseline characteristics, treatments, and outcomes were compared across these frailty categories. Factors associated with postintensive care frailty were identified using ordinal logistic regression fitted with a generalized estimating equation model. Among 513 eligible patients, 339 patients survived to 90 days; 103 patients (30.4%) had no-to-mild frailty, 114 patients (33.6%) had moderate frailty, and 122 patients (36.0%) had severe frailty, respectively. Higher presepsis CFS scores (adjusted odds ratio [aOR], 2.03 [1.72-2.40] per 1-point increase; p < 0.001), higher sequential organ failure assessment (SOFA) scores (aOR, 1.16 [1.06-1.26] per 1-point increase; p < 0.001), and corticosteroid use (aOR, 1.72 [1.14-2.61]; p < 0.001) were independently associated with frailty. Subgroup analyses revealed that corticosteroid use was associated with frailty deterioration in patients with baseline frailty (CFS ≥ 5), whereas SOFA scores were associated with frailty in patients with tissue hypoperfusion (lactate, ≥ 2 mmol/L).
Conclusions:
Baseline frailty before sepsis, organ dysfunction severity, and corticosteroid therapy independently predict severe postintensive care frailty in older adults with septic shock.