Frailty Syndrome and Risk of Sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort

Mythreyi Mahalingam, Justin Xavier Moore, John P. Donnelly, Monika M. Safford, Henry E. Wang

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations

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 languageEnglish
Pages (from-to)292-300
Number of pages9
JournalJournal of Intensive Care Medicine
Volume34
Issue number4
DOIs
StatePublished - 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.

FundersFunder 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 ResourcesUL1RR025777
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 InstituteR25CA047888
National Childhood Cancer Registry – National Cancer Institute
University of AlabamaU01-NS041588
University of Alabama
Agency for Healthcare Research and QualityR25-CA47888, T32HS013852
Agency for Healthcare Research and Quality
Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke CouncilU01NS041588
Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council
National Institute of Health National Institute of Nursing ResearchR01NR012726
National Institute of Health National Institute of Nursing Research

    Keywords

    • epidemiology
    • frailty
    • infection
    • sepsis

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

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