Table 1. Characteristics of patients with suspected infection
|
Fit (CFS 1–3)
|
Vulnerable (CFS 4)
|
Frail (CFS 5–9)
|
|
|
|
n=337 (51.8)
|
n=109 (16.8)
|
n=204 (31.4)
|
p-value
|
Age at admission (years old)
|
|
67 (54–78)
|
73 (64–81)
|
77 (69–84)
|
<0.01
|
Sex, male
|
|
199 (59.1)
|
68 (62.4)
|
102 (50.0)
|
0.05
|
BMI (kg/m2)
|
|
22.4 (20.0–25.0)
|
22.5 (19.6–24.9)
|
20.8 (17.8–23.6)
|
<0.01
|
Coexisting conditions
|
Myocardial infarction
|
11 (3.3)
|
7 (6.4)
|
7 (3.4)
|
0.33
|
Congestive heart failure
|
20 (5.9)
|
11 (10.1)
|
28 (13.7)
|
<0.01
|
Peripheral vascular disease
|
9 (2.7)
|
7 (6.4)
|
7 (3.4)
|
0.17
|
Cerebrovascular disease
|
20 (5.9)
|
9 (8.3)
|
30 (14.7)
|
<0.01
|
Dementia
|
12 (3.6)
|
15 (13.8)
|
48 (23.5)
|
<0.01
|
COPD
|
12 (3.6)
|
13 (11.9)
|
30 (14.7)
|
<0.01
|
Connective tissue disease
|
14 (4.2)
|
13 (11.9)
|
19 (9.3)
|
<0.01
|
Peptic ulcer disease
|
13 (3.9)
|
1 (0.9)
|
10 (4.9)
|
0.19
|
Diabetes mellitus without organ damage
|
47 (13.9)
|
22 (20.2)
|
42 (20.6)
|
0.09
|
Diabetes mellitus with organ damage
|
28 (8.3)
|
19 (17.4)
|
14 (6.9)
|
<0.01
|
Chronic kidney disease
|
19 (5.6)
|
20 (18.3)
|
16 (7.8)
|
<0.01
|
Hemiplegia
|
3 (0.9)
|
3 (2.8)
|
25 (12.3)
|
<0.01
|
Malignancy (solid)
|
30 (8.9)
|
19 (17.4)
|
28 (13.7)
|
0.03
|
Malignancy (blood)
|
6 (1.8)
|
0
|
1 (0.5)
|
0.18
|
Metastatic tumor
|
6 (1.8)
|
4 (3.7)
|
5 (2.5)
|
0.46
|
Mild liver disease
|
8 (2.4)
|
11 (10.1)
|
9 (4.4)
|
<0.01
|
Moderate to severe liver disease
|
13 (3.9)
|
1 (0.9)
|
9 (4.4)
|
0.26
|
AIDS
|
0
|
0
|
0
|
|
CCI
|
|
1 (0–2)
|
2 (1–4)
|
2 (1–3)
|
<0.01
|
SOFA score
|
|
7 (4–10)
|
8 (5–11)
|
7 (5–10)
|
0.59
|
APACHE II score
|
|
18 (12–25)
|
22 (17–28)
|
21 (15–27)
|
<0.01
|
Septic shock
|
|
60 (17.8)
|
23 (21.1)
|
28 (13.7)
|
0.22
|
Mechanical ventilation
|
|
132 (39.3)
|
46 (43.4)
|
74 (36.5)
|
0.49
|
Vital signs
|
Glasgow coma scale
|
13 (8–15)
|
11 (8–15)
|
12 (7–14)
|
<0.01
|
|
Systolic blood pressure (mmHg)
|
107 (87–128)
|
105 (80–137)
|
109 (86–128)
|
0.97
|
|
Heat rate (/min)
|
105 (88–125)
|
108 (90–120)
|
103 (86–118)
|
0.18
|
|
Respiratory rate (/min)
|
24 (19–29)
|
22 (18–27)
|
23 (19–30)
|
0.42
|
|
Body temperature (℃)
|
37.5 (36.5–38.5)
|
37.5 (36.4–38.6)
|
37.0 (36.3–38.1)
|
0.03
|
Laboratory data
|
White blood cells (/μL)
|
11000 (5780–15580)
|
10520 (6700–16000)
|
11780 (7450–17200)
|
0.32
|
|
Hematocrit (%)
|
35.4 (29.3–40.8)
|
33.1 (26.8–39.1)
|
34.4 (29.4–39.9)
|
0.07
|
|
Platelet (/μL)
|
16.3 (9.8–24.4)
|
18.0 (11.2–24.3)
|
18.1 (12.9–25.5)
|
0.16
|
|
PT-INR
|
1.2 (1.1–1.4)
|
1.2 (1.1–1.4)
|
1.2 (1.1–1.4)
|
0.83
|
|
Lactate (mmol/L)
|
2.6 (1.4–4.4)
|
2.7 (1.6–5.7)
|
2.5 (1.4–4.4)
|
0.27
|
|
Glucose (mg/dL)
|
142 (112–205)
|
150 (109–210)
|
138 (103–194)
|
0.39
|
|
Sodium (mEq/L)
|
138 (134–141)
|
138 (135–141)
|
138 (134–141)
|
0.94
|
|
Potassium (mEq/L)
|
4.0 (3.6–4.5)
|
4.0 (3.4–4.7)
|
4.1 (3.6–4.6)
|
0.40
|
|
Creatinine (mg/dL)
|
1.5 (0.8–2.6)
|
1.6 (0.9–2.9)
|
1.2 (0.7–2.1)
|
0.02
|
|
Total bilirubin (mg/dL)
|
0.8 (0.5–1.5)
|
0.8 (0.5–1.5)
|
0.7 (0.5–1.1)
|
0.02
|
|
C-reactive protein (mg/dL)
|
13.6 (4.6–24.5)
|
12.1 (3.9–24.9)
|
10.5 (3.0–21.0)
|
0.04
|
Positive blood cultures
|
|
141 (44.2)
|
49 (47.6)
|
85 (44.5)
|
0.84
|
Site of infection at final diagnosis
|
Lung
|
103 (30.6)
|
39 (35.8)
|
81 (39.7)
|
<0.01
|
Abdomen
|
74 (22.0)
|
21 (19.3)
|
35 (17.2)
|
Urinary tract
|
49 (14.5)
|
13 (11.9)
|
44 (21.6)
|
Soft Tissue
|
43 (12.8)
|
18 (16.5)
|
20 (9.8)
|
Others
|
35 (10.4)
|
9 (8.3)
|
7 (3.4)
|
Reported counts (proportions) for categorical and median (interquartile range) for continuous variables.
Continuous variables were compared using the Mann–Whitney U test. Categorical variables were compared using the Fisher’s exact test or chi square test, where appropriately.
Missing data: BMI=5; Metastatic tumor=1; Mechanical ventilation=2; Systolic blood pressure=2; Heart rate=1; Temperature=1; Hematocrit=1; PT–INR=5; Lactate=15; Glucose=6; Total bilirubin=1; C-reactive protein=2; Positive blood cultures=37
CFS: Clinical frailty scale, BMI: Body mass index, COPD: Chronic obstructive pulmonary disease, AIDS: Acquired immunodeficiency syndrome, CCI: Charlson comorbidity index, SOFA: Sequential organ failure assessment, APACHE: Acute physiology and chronic health evaluation, PT-INR: International normalized ratio of prothrombin time
Table 2. Outcomes of patients with suspected infection
|
|
Fit (CFS 1–3)
|
Vulnerable (CFS 4)
|
Frail (CFS 5–9)
|
p-value
|
|
|
n=337 (51.8)
|
n=109 (16.8)
|
n=204 (31.4)
|
p-value
|
In-hospital mortality
|
Overall
|
55/335 (16.4)
|
23/107 (21.5)
|
45/203 (22.2)
|
0.19
|
|
30-day
|
40/335 (11.9)
|
16/107 (15.0)
|
34/203 (16.7)
|
0.26
|
|
90-day
|
51/335 (15.2)
|
22/107 (20.6)
|
44/203 (21.7)
|
0.13
|
Dispositions
|
Home
|
125/280 (44.6)
|
36/84 (42.9)
|
40/158 (25.3)
|
<0.01
|
|
Transfer
|
155/280 (55.4)
|
48/84 (57.1)
|
118/158 (74.7)
|
ICU-free days
|
|
16 (0–22)
|
17 (0–22)
|
15 (0–22)
|
0.85
|
Ventilator–free days
|
|
21 (0–28)
|
21 (8–28)
|
20 (0–28)
|
0.71
|
Length of hospital stay
|
|
22 (10–49)
|
23 (14–41)
|
23 (11–40)
|
0.86
|
Reported counts (proportions) for categorical and median (interquartile range) for continuous variables. Continuous variables were compared using the Mann–Whitney U test. Categorical variables were compared using the Fisher’s exact test or chi square test, where appropriately.
Missing data: In–hospital mortality=5; ICU–free days=41; Ventilator–free days=41; Length of hospital stay=5
CFS: Clinical frailty scale, ICU: Intensive care unit
Table 3. Univariable and multivariable analysis for mortality associated with frailty in patients with suspected infection
Univariable analysis
|
|
HR
|
95% CI
|
p-value
|
Frailty
|
Vulnerable vs fit
|
1.33
|
0.82
|
2.16
|
0.25
|
|
Frail vs fit
|
1.36
|
0.92
|
2.01
|
0.13
|
Multivariable analysis
|
|
HR
|
95% CI
|
p-value
|
Age
|
|
1.01
|
1.00
|
1.03
|
0.04
|
Sex, male
|
|
1.10
|
0.76
|
1.61
|
0.61
|
Charlson comorbidity index
|
|
1.04
|
0.95
|
1.15
|
0.39
|
SOFA score
|
|
1.18
|
1.14
|
1.24
|
<0.01
|
Frailty
|
Vulnerable vs fit
|
1.16
|
0.70
|
1.92
|
0.57
|
|
Frail vs fit
|
1.13
|
0.75
|
1.72
|
0.56
|
HR: Hazard ratio, CI: Confidence Interval, SOFA: Sequential organ failure assessment
Table 4. Characteristics of patients with sepsis
|
|
Fit (CFS 1–3)
|
Vulnerable (CFS 4)
|
Frail (CFS 5–9)
|
|
|
|
303 (50.6)
|
104 (17.4)
|
192 (32.1)
|
p-value
|
Age at admission (years old)
|
|
68 (55–78)
|
73 (64–81)
|
78 (69–84)
|
<0.01
|
Sex. male
|
|
175 (57.8)
|
66 (63.5)
|
96 (50.0)
|
0.06
|
BMI (kg/m2)
|
|
22.6 (20.0–25.0)
|
22.5 (20.0–24.8)
|
20.8 (17.8–23.3)
|
<0.01
|
Coexisting conditions
|
Myocardial infarction
|
8 (2.6)
|
7 (6.7)
|
6 (3.1)
|
0.14
|
Congestive heart failure
|
19 (6.3)
|
11 (10.6)
|
26 (13.5)
|
0.02
|
Peripheral vascular disease
|
9 (3.0)
|
6 (5.8)
|
6 (3.1)
|
0.38
|
Cerebrovascular disease
|
19 (6.3)
|
9 (8.7)
|
29 (15.1)
|
0.01
|
Dementia
|
11 (3.6)
|
15 (14.4)
|
47 (24.5)
|
<0.01
|
COPD
|
11 (3.6)
|
12 (11.5)
|
27 (14.1)
|
<0.01
|
Connective tissue disease
|
12 (4.0)
|
13 (12.5)
|
17 (8.9)
|
0.01
|
Peptic ulcer disease
|
13 (4.3)
|
1 (1.0)
|
10 (5.2)
|
0.19
|
Diabetes mellitus without organ damage
|
44 (14.5)
|
21 (20.2)
|
39 (20.3)
|
0.18
|
Diabetes mellitus with organ damage
|
24 (7.9)
|
18 (17.3)
|
12 (6.2)
|
<0.01
|
Chronic kidney disease
|
17 (5.6)
|
19 (18.3)
|
15 (7.8)
|
<0.01
|
Hemiplegia
|
3 (1.0)
|
3 (2.9)
|
24 (12.5)
|
<0.01
|
Malignancy (solid)
|
26 (8.6)
|
18 (17.3)
|
25 (13.0)
|
0.04
|
Malignancy (blood)
|
6 (2.0)
|
0
|
1 (0.5)
|
0.24
|
Metastatic tumor
|
6 (2.0)
|
4 (3.8)
|
5 (2.6)
|
0.57
|
Mild liver disease
|
8 (2.6)
|
11 (10.6)
|
7 (3.6)
|
<0.01
|
Moderate to severe liver disease
|
12 (4.0)
|
1 (1.0)
|
9 (4.7)
|
0.25
|
AIDS
|
0
|
0
|
0
|
|
CCI
|
|
1 (0–2)
|
2 (1–4)
|
2 (1–3)
|
<0.01
|
SOFA score
|
|
8 (5–11)
|
8 (5–11)
|
7 (5–10)
|
0.75
|
APACHE II score
|
|
19 (14–26)
|
24 (18–28)
|
21 (15–28)
|
<0.01
|
Septic shock
|
|
59 (19.5)
|
23 (22.1)
|
27 (14.1)
|
0.17
|
Mechanical ventilation
|
|
120 (39.6)
|
46 (45.1)
|
69 (35.9)
|
0.31
|
Vital signs
|
Glasgow coma scale
|
13 (7–15)
|
11 (8–14)
|
11 (7–14)
|
<0.01
|
|
Systolic blood pressure (mmHg)
|
105 (85–127)
|
100 (79–132)
|
109 (86–128)
|
0.88
|
|
Heat rate (/min)
|
106 (90–126)
|
108 (90–121)
|
104 (86–119)
|
0.19
|
|
Respiratory rate (/min)
|
24 (19–30)
|
22 (18–27)
|
24 (19–30)
|
0.17
|
|
Body temperature (℃)
|
37.5 (36.6–38.5)
|
37.3 (36.4–38.5)
|
37.1 (36.3–38.2)
|
0.04
|
Laboratory data
|
White blood cells (/μL)
|
11000 (5650–15895)
|
10555 (6625–15925)
|
11660 (7568–17250)
|
0.35
|
|
Hematocrit (%)
|
35.5 (29.5–40.8)
|
33.1 (26.8–39.2)
|
34.3 (29.3–39.9)
|
0.04
|
|
Platelet (/μL)
|
15.9 (9.8–23.7)
|
16.8 (11.0–24.2)
|
18.0 (12.8–25.5)
|
0.10
|
|
PT-INR
|
1.2 (1.1–1.4)
|
1.2 (1.1–1.4)
|
1.2 (1.1–1.4)
|
0.92
|
|
Lactate (mmol/L)
|
2.6 (1.5–4.8)
|
2.7 (1.7–5.9)
|
2.7 (1.6–4.4)
|
0.43
|
|
Glucose (mg/dL)
|
139 (110–205)
|
144 (108–204)
|
136 (102–194)
|
0.44
|
|
Sodium (mEq/L)
|
137 (134–141)
|
137 (135–141)
|
138 (134–142)
|
0.59
|
|
Potassium (mEq/L)
|
4.0 (3.6–4.6)
|
4.0 (3.4–4.7)
|
4.1 (3.6–4.6)
|
0.53
|
|
Creatinine (mg/dL)
|
1.5 (0.9–2.8)
|
1.6 (0.9–3.0)
|
1.3 (0.7–2.1)
|
0.01
|
|
Total bilirubin (mg/dL)
|
0.9 (0.6–1.5)
|
0.9 (0.5–1.5)
|
0.7 (0.50–1.1)
|
0.01
|
|
C-reactive protein (mg/dL)
|
14.4 (5.4–24.7)
|
12.2 (4.0–25.3)
|
11.1 (3.0–21.1)
|
0.03
|
Positive blood cultures
|
|
135 (46.6)
|
47 (47.5)
|
82 (45.6)
|
0.95
|
Site of infection at final diagnosis
|
Lung
|
90 (29.7)
|
38 (36.5)
|
79 (41.1)
|
<0.01
|
Abdomen
|
67 (22.1)
|
20 (19.2)
|
32 (16.7)
|
Urinary tract
|
47 (15.5)
|
13 (12.5)
|
41 (21.4)
|
Soft Tissue
|
36 (11.9)
|
16 (15.4)
|
18 (9.4)
|
Others
|
33 (10.9)
|
8 (7.7)
|
7 (3.6)
|
Reported counts (proportions) for categorical and median (interquartile range) for continuous variables.
Continuous variables were compared using the Mann–Whitney U test. Categorical variables were compared using the Fisher’s exact test or chi square test, where appropriately.
Missing data: BMI=5; Metastatic tumor=1; Systolic blood pressure=2; Heart rate=1; Temperature =1; Hematocrit=1; PT-INR=2; Lactate=9; Glucose=4; Total bilirubin=1; C–reactive protein =1; Positive blood cultures=30
CFS: Clinical frailty scale, BMI: Body mass index, COPD: Chronic obstructive pulmonary disease, AIDS: Acquired immunodeficiency syndrome, CCI: Charlson comorbidity index, SOFA: Sequential organ failure assessment, APACHE: Acute physiology and chronic health evaluation, PT–INR: International normalized ratio of prothrombin time
Table 5. Outcomes of patients with sepsis
|
|
Fit (CFS 1–3)
|
Vulnerable (CFS 4)
|
Frail (CFS 5–9)
|
|
|
|
303 (50.6)
|
104 (17.4)
|
192 (32.1)
|
p-value
|
In-hospital mortality
|
Overall
|
51/302 (16.9)
|
23/102 (22.5)
|
44/191 (23.0)
|
0.18
|
|
30-day
|
38/302 (12.6)
|
16/102 (15.7)
|
34/191 (17.8)
|
0.26
|
|
90-day
|
47/302 (15.6)
|
22/102 (21.6)
|
43/191 (22.5)
|
0.11
|
Dispositions
|
Home
|
110/251 (43.8)
|
34/79 (43.0)
|
36/147 (24.5)
|
<0.01
|
|
Transfer
|
141/251 (56.2)
|
45/79 (57.0)
|
111/147 (75.5)
|
ICU–free days
|
|
15 (0–21)
|
16 (0–21)
|
14 (0–22)
|
0.83
|
Ventilator–free days
|
|
21 (0–28)
|
21 (6–28)
|
20 (0–28)
|
0.87
|
Length of hospital stay
|
|
23 (10–49)
|
23 (14–40)
|
23 (11–40)
|
0.98
|
Reported counts (proportions) for categorical and median (interquartile range) for continuous variables.
Continuous variables were compared using the Mann–Whitney U test. Categorical variables were compared using the Fisher’s exact test or chi square test, where appropriately.
Missing data: In-hospital mortality=4; ICU–free days=40; Ventilator–free days=40; Length of hospital stay=4
CFS: Clinical frailty scale, ICU: Intensive care unit
Table 6. Univariable and multivariable analysis for mortality associated with frailty in patients with sepsis
Univariable analysis
|
|
HR
|
95% CI
|
p-value
|
Frailty
|
Vulnerable vs fit
|
1.41
|
0.86
|
2.30
|
0.18
|
|
Frail vs fit
|
1.40
|
0.94
|
2.10
|
0.10
|
Multivariable analysis
|
|
HR
|
95% CI
|
p-value
|
Age
|
|
1.01
|
1.00
|
1.03
|
0.04
|
Sex. male
|
|
1.15
|
0.78
|
1.68
|
0.49
|
Charlson comorbidity Index.
|
|
1.05
|
0.95
|
1.16
|
0.32
|
SOFA score
|
|
1.20
|
1.15
|
1.26
|
<0.01
|
Frailty
|
Vulnerable vs fit
|
1.22
|
0.73
|
2.04
|
0.45
|
|
Frail vs fit
|
1.26
|
0.82
|
1.93
|
0.29
|
HR: Hazard ratio, CI: Confidence Interval, SOFA: Sequential organ failure assessment