Figure 2 - uploaded by Pierre Garçon
Content may be subject to copyright.
Kaplan Meier curves of VIPs admitted with sepsis, in comparison to other acutely admitted VIPs with SOFA ≥ 2; (a) unadjusted and (b) and adjusted curves for 6 months survival.

Kaplan Meier curves of VIPs admitted with sepsis, in comparison to other acutely admitted VIPs with SOFA ≥ 2; (a) unadjusted and (b) and adjusted curves for 6 months survival.

Source publication
Article
Full-text available
Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To...

Contexts in source publication

Context 1
... is defined as a clinical state of increased vulnerability from age-associated decline in physiological reserves and function in many physiological systems and was assessed according to the CFS [14,17]. This scale is composed of nine classes from very fit (i) to terminally ill (9) (see Appendix Figure A2). The frailty level present before hospital admission and not affected by the acute illness was used. ...
Context 2
... analysis of 6 months survival was performed and both the unadjusted and adjusted Kaplan Meier survival curves for 6 months survival are shown in Figure 2. Significant differences in 6-month mortality were observed between VIPs admitted with sepsis and the other acutely admitted VIPs (P = 0.01, Figure 2a), but not after adjustment for age, gender, SOFA score, CPS, habitat before admission and frailty (P = 0.51, Figure 2b). ...
Context 3
... analysis of 6 months survival was performed and both the unadjusted and adjusted Kaplan Meier survival curves for 6 months survival are shown in Figure 2. Significant differences in 6-month mortality were observed between VIPs admitted with sepsis and the other acutely admitted VIPs (P = 0.01, Figure 2a), but not after adjustment for age, gender, SOFA score, CPS, habitat before admission and frailty (P = 0.51, Figure 2b). ...
Context 4
... analysis of 6 months survival was performed and both the unadjusted and adjusted Kaplan Meier survival curves for 6 months survival are shown in Figure 2. Significant differences in 6-month mortality were observed between VIPs admitted with sepsis and the other acutely admitted VIPs (P = 0.01, Figure 2a), but not after adjustment for age, gender, SOFA score, CPS, habitat before admission and frailty (P = 0.51, Figure 2b). ...

Similar publications

Article
Full-text available
Abstract Background: Journal club is an essential teaching-learning activity that provides a forum for developing skills in critical appraisal. It helps in keeping abreast of new knowledge, facilitating the application of new research in improving patient care, and aiding medical students to be competent clinicians. The current study aimed to eluci...

Citations

... Frail patients are indeed at high risk of functional and cognitive decline, falls, disability, and mortality after hospitalization [14]. In the Intensive Care Units (ICU), measures of frailty demonstrated to be accurate in stratifying the prognosis of older people affected by sepsis and other critical illnesses [15][16][17][18]. However, sepsis is common also in other acute hospital wards. ...
... Sepsis is one of the most frequent reasons for acute ICU admission of older patients with high mortality rates [18]. However, older persons with sepsis are often hospitalized even in non-ICU settings, such as acute geriatric and medical wards. ...
Article
Full-text available
Background A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging. Aims To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis. Methods All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed. Results We included 240 patients (median age = 85, IQR = 80–89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610–0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532–0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637–0.768) and the FI (AUROC = 0.677, 95% CI 0.607–0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term. Conclusions Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
... The term "frailty" describes an individual's risk to become dependent or even die when exposed to a stressor and is widely used in geriatric medicine [29]. In intensive care medicine, frailty is an independent predictor of longterm mortality [30]. In other surgical specialties like orthopedics, it is associated with increased need of revision surgery and concomitant morbidity [31]. ...
Article
Full-text available
Purpose The Clinical Frailty Scale (CFS) evaluates patients’ level of frailty on a scale from 1 to 9 and is commonly used in geriatric medicine, intensive care and orthopedics. The aim of our study was to reveal whether the CFS allows a reliable prediction of overall survival (OS) in patients after surgical treatment of brain metastases (BM) compared to the Karnofsky Performance Score (KPS). Methods Patients operated for BM were included. CFS and KPS were retrospectively assessed pre- and postoperatively and at follow-up 3–6 months after resection. Results 205 patients with a follow-up of 22.8 months (95% CI 18.4–27.1) were evaluated. CFS showed a median of 3 (“managing well”; IqR 2–4) at all 3 assessment-points. Median KPS was 80 preoperatively (IqR 80–90) and 90 postoperatively (IqR 80–100) as well as at follow-up after 3–6 months. CFS correlated with KPS both preoperatively (r = − 0.92; p < 0.001), postoperatively (r = − 0.85; p < 0.001) and at follow-up (r = − 0.93; p < 0.001). The CFS predicted the expected reduction of OS more reliably than the KPS at all 3 assessments. A one-point increase (worsening) of the preoperative CFS translated into a 30% additional hazard to decease (HR 1.30, 95% CI 1.15–1.46; p < 0.001). A one-point increase in postoperative and at follow-up CFS represents a 39% (HR 1.39, 95% CI 1.25–1.54; p < 0.001) and of 42% risk (HR 1.42, 95% CI 1.27–1.59; p < 0.001). Conclusion The CFS is a feasible, simple and reliable scoring system in patients undergoing resection of brain metastasis. The CFS 3–6 months after surgery specifies the expected OS more accurately than the KPS.
... This scale was initially introduced in geriatric medicine, where frailty manifests in sarcopenia, abnormal inflammatory and endocrine function as well as poor energy regulation [3,4]. In intensive care medicine, frailty has been identified as a predictor for long-term mortality [5] and in orthopaedic surgery it serves to forecast unplanned repeat operations and consequent morbidity [6]. A CFS ≤ 4 is considered to describe patients that are 'non-frail'. ...
Article
Full-text available
Background The Clinical Frailty Scale (CFS) describes the general level of fitness or frailty and is widely used in geriatric medicine, intensive care and orthopaedic surgery. This study was conducted to analyze, whether CFS could be used for patients with high-grade glioma. Methods Patients harboring high-grade gliomas, undergoing first resection at our center between 2015 and 2020 were retrospectively evaluated. Patients’ performance was assessed using the Rockwood Clinical Frailty Scale and the Karnofsky Performance Scale (KPS) preoperatively and 3–6 months postoperatively. Results 289 patients were included. Pre- as well as postoperative median frailty was 3 CFS points (IqR 2–4) corresponding to “managing well”. CFS strongly correlated with KPS preoperatively (r = − 0.85; p < 0.001) and at the 3–6 months follow-up (r = − 0.90; p < 0.001). The reduction of overall survival (OS) was 54% per point of CFS preoperatively (HR 1.54, CI 95% 1.38–1.70; p < 0.001) and 58% at the follow-up (HR 1.58, CI 95% 1.41–1.78; p < 0.001), comparable to KPS. Patients with IDH mutation showed significantly better preoperative and follow-up CFS and KPS (p < 0.05). Age and performance scores correlated only mildly with each other (r = 0.21…0.35; p < 0.01), but independently predicted OS (p < 0.001 each). Conclusion CFS seems to be a reliable tool for functional assessment of patients suffering from high-grade glioma. CFS includes non-cancer related aspects and therefore is a contemporary approach for patient evaluation. Its projection of survival can be equally estimated before and after surgery. IDH-mutation caused longer survival and higher functionality.
... In our ageing society, there are increasing possibilities for medical treatment, especially in critical care, and growing numbers of frail pre-ICU patients are being ad-Bertschi/Waskowski/Schilling/Donatsch/ Schefold/Pfortmueller Gerontology 2 DOI: 10.1159/000523674 mitted to intensive care units (ICUs) [1,2]. Frailty in the general population has a high prevalence and affects 7-11% of persons aged 65 years and older and 25-40% of those aged 80 years and over [3][4][5]. Nonetheless, it is frequently overlooked since medical consultations often assess specific health or organ problems rather than assessing the global health and functional state of a patient [6]. Therefore, pre-ICU frailty should be assessed before or during the early period after admitting a patient to an ICU, in order to evaluate the extent to which burdensome intensive care treatments might be beneficial for the individual patient [7,8]. ...
Article
Introduction: As new treatments have become established, more frail pre-ICU patients are being admitted to intensive care units (ICUs); this is creating new challenges to provide adequate care and to ensure that resources are allocated in an ethical and economical manner. This systematic review evaluates the current standard for assessing frailty on the ICU, including methods of assessment, time point of measurements, and cut-offs. Methods: A systematic search was conducted on MEDLINE, Clinical Trials, Cochrane Library, and Embase. Randomized and non-randomized controlled studies were included that evaluated diagnostic tools and ICU outcomes for frailty. Exclusion criteria were the following: studies without baseline assessment of frailty on ICU admission, studies in paediatric patients or pregnant women, and studies that targeted very narrow populations of ICU patients. Eligible articles were included until January 31, 2021. Methodological quality was assessed using the Newcastle-Ottawa Scale. No meta-analysis was performed, due to heterogeneity. Results: N = 57 articles (253,376 patients) were included using 19 different methods to assess frailty or a surrogate. Frailty on ICU admission was most frequently detected using the Clinical Frailty Scale (CFS) (n = 35, 60.3%), the Frailty Index (n = 5, 8.6%), and Fried's frailty phenotype (n = 6, 10.3%). N = 22 (37.9%) studies assessed functional status. Cut-offs, time points, and manner of baseline assessment of frailty on ICU admission varied widely. Frailty on ICU admission was associated with short- and long-term mortality, functional and cognitive impairment, increased health care dependency, and impaired quality of life post-ICU discharge. Conclusions: Frailty assessment on the ICU is heterogeneous with respect to methods, cut-offs, and time points. The CFS may best reflect frailty in the ICU. Frailty assessments should be harmonized and performed routinely in the critically ill.
... Third, the EHR had no information on frailty status, a physiological condition characterised by a decreased reserve to stressors [24]. Reliable, easy-to-use, and validated instruments are available, such as the Clinical Frailty Scale [25][26][27][28][29], and this scale has been shown to correlate with outcomes for several pathologies in multicentre studies [25][26][27][28][29]. Unfortunately, this variable was not available to us. Fourthly, delirium is associated with higher mortality, and it is one of the most consequential geriatric syndromes, especially in septic patients, but it was not considered in our study despite its potential influence on mortality. ...
... Third, the EHR had no information on frailty status, a physiological condition characterised by a decreased reserve to stressors [24]. Reliable, easy-to-use, and validated instruments are available, such as the Clinical Frailty Scale [25][26][27][28][29], and this scale has been shown to correlate with outcomes for several pathologies in multicentre studies [25][26][27][28][29]. Unfortunately, this variable was not available to us. ...
Article
Full-text available
Background In older adult patients, bloodstream infections cause significant mortality. However, data on long-term prognosis in very elderly patients are scarce. This study aims to assess 1-year mortality from bacteraemia in very elderly patients. Methods Retrospective cohort study in inpatients aged 80 years or older and suspected of having sepsis. Patients with (n = 336) and without (n = 336) confirmed bacteraemia were matched for age, sex, and date of culture, and their characteristics were compared. All-cause mortality and risk of death were assessed using the adjusted hazard ratio (aHR). Results Compared to controls, cases showed a higher 1-year mortality (34.8% vs. 45.2%) and mortality rate (0.46 vs. 0.69 deaths per person-year). Multivariable analysis showed significant risk of 1-year mortality in patients with bacteraemia (aHR: 1.31, 95% confidence interval [CI] 1.03–1.67), quick Sepsis Related Organ Failure Assessment (qSOFA) score of 2 or more (aHR: 2.71, 95% CI 2.05–3.57), and age of 90 years or older (aHR 1.53, 95% CI 1.17–1.99). Conclusions In elderly patients suspected of sepsis, bacteraemia is associated with a poor prognosis and higher long-term mortality. Other factors related to excess mortality were age over 90 years and a qSOFA score of 2 or more.
... The term "frailty" describes an individual's risk to become dependent or even die when exposed to a stressor and is widely used in geriatric medicine [29]. In intensive care medicine, frailty is an independent predictor of long-term mortality [30]. In other surgical specialties like orthopedics, it is associated with increased need of revision surgery and concomitant morbidity [31]. ...
Preprint
Purpose: The Clinical Frailty Scale (CFS) evaluates patients’ level of frailty on a scale from 1 to 9 and is commonly used in geriatric medicine, intensive care and orthopedics. The aim of our study was to reveal whether the CFS allows a reliable prediction of overall survival (OS) in patients after surgical treatment of brain metastases (BM) compared to the Karnofsky Performance Score (KPS). Methods: Patients operated for BM were included. CFS and KPS were retrospectively assessed pre- and postoperatively and at follow-up 3-6 months after resection. Results: 205 patients with a follow-up of 22.8 months (CI95%, 18.4-27.1) were evaluated. CFS showed a median of 3 (“managing well”; IqR 2-4) at all 3 assessment-points. Median KPS was 80 preoperatively (IqR 80-90) and 90 postoperatively (IqR 80-100) as well as at follow-up after 3-6 months. CFS correlated with KPS both preoperatively (r=-0.92; p<0.001), postoperatively (r=-0.85; p<0.001) and at follow-up (r= -0.93; p<0.001). The CFS predicted the expected reduction of OS more reliably than the KPS at all 3 assessments. A one-point increase (worsening) of the preoperative CFS translated into a 30% additional hazard to decease (HR=1.30, CI95% 1.15-1.46; p<0.001). A one-point increase in postoperative and at follow-up CFS represents a 39% (HR=1.39, CI95% 1.25-1.54; p<0.001) and of 42% risk (HR= 1.42, CI95% 1.27-1.59; p<0.001). Conclusion: The CFS is a feasible, simple and reliable scoring system in patients undergoing resection of brain metastasis. The CFS 3-6 months after surgery specifies the expected OS more accurately than the KPS.
... In a very recent preliminary analysis McIntyre et al. found that frailty was associated with worse surgical outcomes following chronic subdural hemorrhage, but the clinical utility of the frailty scores remained unclear (8). In a large prospective multinational study Haas et al. demonstrated that frailty was significantly associated with an increased 6-month mortality in elderly intensive care patients admitted with sepsis (9). ...
... In the CFS group a small prospective observational study by Goeteyn et al. reported a mean length of stay of 14.6 days which was distributed evenly in both frail and non-frail groups (p = 0.597) (21). On the other hand, Li et al. observed a median LOS 7 days (4)(5)(6)(7)(8)(9)(10)(11) in the non-frail group compared to 13 days (7.5-27.5) in the frail (p < 0.001) (31). The pooled weighted difference in in the CFS subgroup was 4.15 days (CI: −0.21-8.51; ...
Article
Full-text available
Background Frailty, a “syndrome of loss of reserves,” is a decade old concept. Initially it was used mainly in geriatrics but lately its use has been extended into other specialties including surgery. Our main objective was to examine the association between frailty and mortality, between frailty and length of hospital stay (LOS) and frailty and readmission within 30 days in the emergency surgical population. Methods Studies reporting on frailty in the emergency surgical population were eligible. MEDLINE (via PubMed), EMBASE, Scopus, CENTRAL, and Web of Science were searched with terms related to acute surgery and frail * . We searched for eligible articles without any restrictions on the 2nd of November 2020. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI), using a random effect model. Risk of bias assessment was performed according to the recommendations of the Cochrane Collaboration. As the finally selected studies were either prospective or retrospective cohorts, the “Quality In Prognosis Studies” (QUIPS) tool was used. Results At the end of the selection process 21 eligible studies with total 562.070 participants from 8 countries were included in the qualitative and the quantitative synthesis. Patients living with frailty have higher chance of dying within 30 days after an emergency surgical admission (OR: 1.99; CI: 1.76–2.21; p < 0.001). We found a tendency of increased LOS with frailty in acute surgical patients (WMD: 4.75 days; CI: 1.79–7.71; p = 0.002). Patients living with frailty have increased chance of 30-day readmission after discharge (OR: 1.36; CI: 1.06–1.75; p = 0.015). Conclusions Although there is good evidence that living with frailty increases the chance of unfavorable outcomes, further research needs to be done to assess the benefits and costs of frailty screening for emergency surgical patients. Systematic Review Registration The review protocol was registered on the PROSPERO International Prospective Register of Systematic Reviews (CRD42021224689).
... Long-term enrollment of human subjects is complicated by the unknown pre-sepsis immunological and transcriptional makeup, high inter-individual heterogeneity, and diverse clinical presentation of the disease [6]. Furthermore, studying the effect of sepsis or progression of the natural process of aging is inherently difficult as both processes are interconnected and affected by several variables [15,16]. Prior research demonstrated the emergence and, at minimum short-term persistence of several metabolomic and immunological abnormalities in the peri-septic period. ...
Article
Full-text available
Survivors of sepsis often suffer from prolonged post-critical illness syndrome secondary to the immune system’s reprogramming. It is unclear if this process is static and pervasive due to methodological difficulties studying long-term outcomes of sepsis. The purpose of this study is to evaluate transcriptional profiles longitudinally in Drosophila melanogaster in the aftermath of sepsis to provide preliminary data for targets playing a role in post-sepsis immunostasis. Adult Drosophila melanogaster were infected with E. coli, and survivors were euthanized at 7, 14, and 21 days. Control flies were subjected to sham stress. Gene profiling was done with RNA-seq, and potential miRNA factors were computed. Profiling identified 55 unique genes at seven days, 61 unique genes at 14 days, and 78 genes at 21 days in sepsis survivors vs. sham control. Each post-sepsis timepoint had a distinctive transcriptional pattern with a signature related to oxidative stress at seven days, neuronal signal transduction at 14 days, and metabolism at 21 days. Several potential miRNA patterns were computed as potentially affecting several of the genes expressed in sepsis survivors. Our study demonstrated that post-sepsis changes in the transcriptome profile are dynamic and extend well into the Drosophila melanogaster natural life span.
Chapter
No clear cut-off age to define an old patient has been established. According to the World Health Organization (WHO) 2021 definitions, an old patient is defined a person aged 65 years or older. Studies evaluating older patients admitted in intensive care units (ICUs) use an age threshold which varied between 50 and over 90 years, although most papers included patients aged over 80 years. Geriatric management is proposed to patients aged over 75 years, although the weight of age is inferior to the weight of comorbidities and risk of loss of functional status.