Patient characteristics in sepsis-related deaths: prevalence of advanced frailty, comorbidity, and age in a Norwegian hospital trust

• Published in: Infection Vol. 51; no. 4; pp. 1103 - 1115
• Main Authors: Torvik, Marianne Ask, Nymo, Stig Haugset, Nymo, Ståle Haugset, Bjørnsen, Lars Petter, Kvarenes, Hanne Winge, Ofstad, Eirik Hugaas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2023; Springer Nature B.V; Springer Nature
• Subjects: Age; Comorbidity; Death; Family Medicine; Fatalities; Frailty; General Practice; Hospitals; Infectious Diseases; Internal Medicine; Medicine; Medicine & Public Health; Patients; Population studies; Sepsis; Sepsis; Frailty; Comorbidity; Mortality
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-023-02013-y

Objective
To examine the prevalence of advanced frailty, comorbidity, and age among sepsis-related deaths in an adult hospital population.
Methods
Retrospective chart reviews of deceased adults within a Norwegian hospital trust, with a diagnosis of infection, over 2 years (2018–2019). The likelihood of sepsis-related death was evaluated by clinicians as sepsis-related, possibly sepsis-related, or not sepsis-related.
Results
Of 633 hospital deaths, 179 (28%) were sepsis-related, and 136 (21%) were possibly sepsis-related. Among these 315 patients whose deaths were sepsis-related or possibly sepsis-related, close to three in four patients (73%) were either 85 years or older, living with severe frailty (Clinical Frailty Scale, CFS, score of 7 or more), or an end-stage condition prior to the admission. Among the remaining 27%, 15% were either 80–84 years old, living with frailty corresponding to a CFS score of 6, or severe comorbidity, defined as 5 points or more on the Charlson Comorbidity Index (CCI). The last 12% constituted the presumably healthiest cluster, but in this group as well, the majority died with limitations of care due to their premorbid functional status and/ or comorbidity. Findings remained stable if the population was limited to sepsis-related deaths on clinicians’ reviews or those fulfilling the Sepsis-3 criteria.
Conclusions
Advanced frailty, comorbidity, and age were predominant in hospital fatalities where infection contributed to death, with or without sepsis. This is of importance when considering sepsis-related mortality in similar populations, the applicability of study results to everyday clinical work, and future study designs.