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

Sepsis Outcomes Worsened by Frailty: Findings from a National Inpatient Sample | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sepsis Outcomes Worsened by Frailty: Findings from a National Inpatient Sample Weijin Huang, Qundi Yuan, Bofei Dong, Jianrong Zhang, Shuqing Zhang, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6677280/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract 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. Sepsis Frailty Adverse outcomes Hospital frailty risk score (HFRS) Nationwide inpatient Sample (NIS) Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementarytableS1.docx SupplementaryTableS2.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 24 Jun, 2025 Reviewers invited by journal 13 Jun, 2025 Editor invited by journal 22 May, 2025 Editor assigned by journal 21 May, 2025 Submission checks completed at journal 21 May, 2025 First submitted to journal 16 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6677280","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471289622,"identity":"a06d8ee4-4dd8-44d3-84d5-0c1f11bf03de","order_by":0,"name":"Weijin Huang","email":"","orcid":"","institution":"Houjie Clinical College of Guangdong Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weijin","middleName":"","lastName":"Huang","suffix":""},{"id":471289624,"identity":"661b0f2f-f154-4ab7-9dc1-55bfa2a52c81","order_by":1,"name":"Qundi Yuan","email":"","orcid":"","institution":"Houjie Clinical College of Guangdong 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sepsis, Frailty, Adverse outcomes, Hospital frailty risk score (HFRS), Nationwide inpatient Sample (NIS)","lastPublishedDoi":"10.21203/rs.3.rs-6677280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6677280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Sepsis Outcomes Worsened by Frailty: Findings from a National Inpatient Sample","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 09:44:07","doi":"10.21203/rs.3.rs-6677280/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"76183927758132428542618605916197858551","date":"2025-06-25T03:34:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T10:49:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-22T05:54:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T07:46:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-21T07:45:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-05-16T05:16:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a272de2-1503-41af-9762-a0906286acca","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-17T09:44:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 09:44:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6677280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6677280","identity":"rs-6677280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}