Over a third of older septic shock survivors were severely frail at 90 days

Design

Post hoc analysis of a multicentre randomised trial

Population

339 survivors aged ≥65 of septic shock in Japanese ICUs

Primary outcome

Clinical Frailty Scale category at 90 days

Effect

36% severely frail; pre-sepsis CFS aOR 2.03 per point; steroids aOR 1.72

This post hoc analysis used a Japanese ICU trial of blood pressure targets in patients aged 65 or over with septic shock. Of 513 patients, 339 survived to 90 days, when frailty was graded with the Clinical Frailty Scale.

At 90 days, 30% had no or mild frailty, 34% moderate and 36% severe. Severe frailty was associated with frailty before sepsis (adjusted OR 2.03 per point on the scale), higher organ failure scores (aOR 1.16 per point) and corticosteroid use (aOR 1.72). The corticosteroid association was seen mainly in patients already frail before admission.

For families, survival is only part of the story: a third of survivors were severely dependent at three months. Pre-sepsis frailty is the most useful predictor to discuss.

• Record pre-illness Clinical Frailty Scale score at admission for older patients with sepsis.
• Discuss the likelihood of severe dependence, not just survival, with families.
• In patients already frail, weigh the steroid decision carefully — steroid use was linked to worse frailty.
• Plan rehabilitation early for older survivors of septic shock.

Why it matters

Survival figures alone overstate the good outcome for older patients; a third were severely frail at three months.

Don't overread it

The steroid association is observational within a trial not designed to test steroids; sicker patients may have received them.

The statistics, in plain English

An adjusted odds ratio of 2.03 per frailty point means each step up the scale before sepsis roughly doubled the odds of being in a worse frailty category afterwards.

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