Frailty has a stronger association with inflammation than age in older veterans

Epps, Puja Van; Oswald, Douglas M.; Higgins, Patricia A.; Hornick, Thomas; Aung, Htin; Banks, Richard; Wilson, Brigid; Burant, Chris; Gravenstein, Stefan; Canaday, David H.

doi:10.1186/s12979-016-0082-z

Cited by 108 publications

(78 citation statements)

References 35 publications

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“…Some studies have reported that frailty was associated with chronic changes in the immune response, including the imbalance of decline in immune function and increased in ammation. 26,27 Other studies have reported that aging was related to changes in the acute immune response, 28,29 due to dysfunction of immune cells or decreased cytokines working as a part of innate and adaptive immunity. 28 Both frailty and aging may be involved in weakening the acute in ammatory response.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

Komori

Abe²,

Ogura³

et al. 2020

Preprint

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Background: Frailty is associated with morbidity and mortality in patients in intensive care units (ICUs). However, the characteristics of frail patients with suspected infection, including sepsis, remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study conducted by 22 ICUs in Japan. Adult patients (≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes between three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score 1–3), vulnerable (score 4), and frail (score 5–9). We conducted subgroup analysis of patients with sepsis defined based on Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median rating of 3 (3–5) on the CFS were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 were (31.4%) frail. Comorbidities were more common in frail and vulnerable patients than in fit patients. The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (4–10), 8 (5–11), and 7 (5–10), respectively (p = 0.59). The patients' median body temperatures were as follows: fit 37.5 (36.5–38.5)℃; vulnerable 37.5 (36.4–38.6)℃; and frail 37.0 (36.3–38.1)℃ (p < 0.01). C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (4.6–24.5), 12.1 (3.9–24.9), 10.5 (3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during the acute phase. However, more vulnerable and frail patients died after the acute phase than fit patients; this difference was not statistically significant (p = 0.25). Compared with fit or vulnerable patients, fewer frail patients were discharged.Conclusion: Frail and vulnerable patients with suspected infection, including sepsis, tend to have poor disease outcomes after the acute phase of infection.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

Komori

Abe²,

Ogura³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…13 Some studies have reported that frailty was associated with chronic changes in the immune response, including the imbalance of decline in immune function and increased in ammation. 33,34 Other studies have reported that aging was related to changes in the acute immune response, 13,35 due to dysfunction of immune cells or decreased cytokines working as part of innate and adaptive immunity. 35 Both frailty and aging may be involved in weakening of the acute in ammatory response.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of frail patients with suspected infection in intensive care units: a descriptive analysis from a multicenter cohort study

Komori

Abe²,

Ogura

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Frailty is associated with morbidity and mortality in patients admitted to intensive care units (ICUs). However, the characteristics of frail patients with suspected infection remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study, including 22 ICUs in Japan. Adult patients (aged ≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes among three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score, 1–3), vulnerable (score, 4), and frail (score, 5–9). We conducted subgroup analysis of patients with sepsis defined as per Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median CFS score of 3 (interquartile range [IQR] 3–5) were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 (31.4%) were frail. The median patient age was 72 years (IQR 60−81). The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (IQR 4–10), 8 (IQR 5–11), and 7 (IQR 5–10), respectively (p = 0.59). The median body temperatures of fit, vulnerable, and frail patients were 37.5°C (IQR 36.5°C–38.5°C), 37.5°C (IQR 36.4°C–38.6°C), and 37.0°C (IQR 36.3°C–38.1°C), respectively (p < 0.01). The median C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (IQR 4.6–24.5), 12.1 (IQR 3.9–24.9), 10.5 (IQR 3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ among the patients according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during short-term. However, more vulnerable and frail patients died after 30-day than fit patients; this difference was not statistically significant (p = 0.25). Compared with the fit and vulnerable groups, the rate of home discharge was lower in the frail group.Conclusion: Frail and vulnerable patients with suspected infection tend to have poor disease outcomes. However, they did not have a statistically significant increased 90-day mortality risk.

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“…[58][59][60][61][62] An additional complexity associated with prehabilitation is whether the exercise programme needs to be supervised in the community, leading to questions about resources, logistics and costs of maintaining such programmes. Furthermore, older frail people may have underlying chronic inflammation or suffer trauma that impede their ability to build reserve, 63 which potentially limits the benefit of prehabilitation. Future randomized trials, specifically targeting frail older people, are required to establish the efficacy of prehabilitation in the setting of elective surgery.…”

Section: Evidence For Preoperative Optimizationmentioning

confidence: 99%

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

Subramaniam

Tiruvoipati

Lodge

et al. 2020

ANZ Journal of Surgery

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Background The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post‐operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. Methods Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. Results We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. Conclusion Establishing multidisciplinary collaborative services to provide person‐centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large‐scale studies should focus on implementing and evaluating such multicomponent models of care.

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Frailty has a stronger association with inflammation than age in older veterans

Cited by 108 publications

References 35 publications

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study

Characteristics and outcomes of frail patients with suspected infection in intensive care units: a descriptive analysis from a multicenter cohort study

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

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