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J Intensive Care Med. 2019 Apr;34(4):292-300. doi: 10.1177/0885066617715251. Epub 2017 Jul 5.

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

Author information

1
1 School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
2
2 Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
3
3 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
4
4 Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
5
5 Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

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.

KEYWORDS:

epidemiology; frailty; infection; sepsis

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