Abstract
Background: Frailty is associated with increased morbidity and mortality in older persons. We sought to characterize the associations between the frailty syndrome and long-term risk of sepsis in a large cohort of community-dwelling adults. Methods: We analyzed data on 30 239 community-dwelling adult participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We defined frailty as the presence of at least 2 frailty indicators (weakness, exhaustion, and low physical activity). We defined sepsis as hospitalization for a serious infection with ≥2 system inflammatory response syndrome criteria, identified for the period 2003-2012. We determined the associations between frailty and risk of first sepsis and sepsis 30-day case fatality. Results: Among REGARDS participants, frailty was present in 6018 (19.9%). Over the 10-year observation period, there were 1529 first-sepsis hospitalizations. Frailty was associated with increased risk of sepsis (adjusted hazard ratio [HR] 1.44; 95% CI: 1.26 to 1.64). The total number of frailty indicators was associated with increased risk of sepsis (P trend <.001). Among first-sepsis hospitalizations, frailty was associated with increased sepsis 30-day case fatality (adjusted OR 1.62; 95% CI: 1.06 to 2.50). Conclusions: In the REGARDS cohort, frailty was associated with increased long-term risk of sepsis and sepsis 30-day case fatality.
| Original language | English |
|---|---|
| Pages (from-to) | 292-300 |
| Number of pages | 9 |
| Journal | Journal of Intensive Care Medicine |
| Volume | 34 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2019 |
Bibliographical note
Publisher Copyright:© The Author(s) 2017.
Funding
The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org and http://www.regardssepsis.org. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by award R01-NR012726 from the National Institute for Nursing Research, UL1-RR025777 from the National Center for Research Resources, as well as by grants from the Center for Clinical and Translational Science and the Lister Hill Center for Health Policy of the University of Alabama at Birmingham. The parent REGARDS study was supported by cooperative agreement U01-NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Representatives of the funding agencies have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Mr. Donnelly was supported by grant T32-HS013852 from the Agency for Healthcare Research and Quality, Rockville, MD, USA. Mr. Moore received grant support from R25-CA47888 from the National Cancer Institute. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by award R01-NR012726 from the National Institute for Nursing Research, UL1-RR025777 from the National Center for Research Resources, as well as by grants from the Center for Clinical and Translational Science and the Lister Hill Center for Health Policy of the University of Alabama at Birmingham. The parent REGARDS study was supported by cooperative agreement U01-NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Representatives of the funding agencies have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Mr. Donnelly was supported by grant T32-HS013852 from the Agency for Healthcare Research and Quality, Rockville, MD, USA. Mr. Moore received grant support from R25-CA47888 from the National Cancer Institute.
| Funders | Funder number |
|---|---|
| Department of Health and Human Service | |
| Center for Clinical and Translational Science, University of Illinois at Chicago | |
| National Institutes of Health (NIH) | |
| U.S. Department of Health and Human Services | |
| Lister Hill Center for Health Policy of the University of Alabama at Birmingham | |
| National Center for Research Resources | UL1RR025777 |
| National Center for Research Resources | |
| National Center for Advancing Translational Sciences (NCATS) | UL1TR001417 |
| National Center for Advancing Translational Sciences (NCATS) | |
| National Childhood Cancer Registry – National Cancer Institute | R25CA047888 |
| National Childhood Cancer Registry – National Cancer Institute | |
| University of Alabama | U01-NS041588 |
| University of Alabama | |
| Agency for Healthcare Research and Quality | R25-CA47888, T32HS013852 |
| Agency for Healthcare Research and Quality | |
| Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council | U01NS041588 |
| Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council | |
| National Institute of Health National Institute of Nursing Research | R01NR012726 |
| National Institute of Health National Institute of Nursing Research |
Keywords
- epidemiology
- frailty
- infection
- sepsis
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine