Sepsis Outcomes Worsened by Frailty: Findings from a National Inpatient Sample

Purpose: While sepsis remains a leading cause of global mortality, the role of frailty in determining patient outcomes has become increasingly recognized. This study investigated the influence of frailty on hospital course and clinical complications within a comprehensive nationwide sepsis cohort. Methods: Retrospective data from the 2016-2019 National Inpatient Sample (NIS) were analyzed. Sepsis cases were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and stratified by Hospital Frailty Risk Score (HFRS) into low, intermediate, and high-risk frailty categories. Multivariable logistic regression was used to assess the association between frailty risk and clinical outcomes, including complications, length of stay, costs, discharge status, and mortality. Results: The study population comprised 2,070,746 sepsis cases, categorized as low (14.2%), intermediate (71.9%), and high (13.9%) risk for frailty. Compared with the low-risk group, the intermediate- and high-risk groups exhibited significantly higher rates of complications, including cerebrovascular events, delirium, respiratory compromise, and coagulation abnormalities. High-risk individuals demonstrated increased odds of prolonged ventilator support (adjusted odds ratio [aOR], 2.444), extended length of stay (aOR, 3.203), higher hospital costs (aOR, 2.570), adverse discharge outcomes (aOR, 5.247), and death (aOR, 1.978). Conclusions: Frailty is a significant factor influencing hospital outcomes in sepsis patients. Patients with higher frailty risk require more medical resources, experience longer lengths of stay, and have higher mortality rates. Therefore, early frailty risk screening and shared decision-making are crucial for optimizing sepsis management. Early identification and intervention in high-risk patients could improve the outcomes of this patient population.