In-hospital development of new-onset frailty and discharge outcomes among patients with sepsis: a Korean multicenter registry study.

Authors

Eunjeong Choi, Kipoong Kim, Woo Hyun Cho, Jin Ho Jang, Ryoung-Eun Ko, Gee Young Suh, Chae Man Lim, Hye Ju Yeo, Korean Sepsis Alliance (KSA) investigators

Published in

Journal of intensive care. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Frailty is an important marker of vulnerability and poor outcomes in patients with sepsis. Although prior studies have primarily focused on pre-existing frailty or post-discharge outcomes, little is known about the in-hospital development of frailty among patients who are non-frail at baseline.
We conducted a multicenter cohort study using the Korean Sepsis Alliance registry, a prospectively maintained database of adult patients with sepsis across 15 hospitals in South Korea. Analyses were restricted to patients without baseline frailty, defined as a premorbid Clinical Frailty Scale score < 5. The primary analysis categorized patients as remaining non-frail at discharge, having new-onset frailty at discharge, or dying during hospitalization. Multinomial logistic regression with prespecified covariates was used to evaluate clinical factors associated with these mutually exclusive outcomes, with in-hospital death treated as a competing outcome. Among hospital survivors, discharge destination was described according to discharge frailty status. In an exploratory analysis restricted to patients with new-onset frailty, we evaluated clinical factors associated with home discharge.
Among 6336 patients without baseline frailty, 1453 (22.9%) had new-onset frailty and 1527 (24.1%) died during hospitalization. Older age (per 1-SD increase, adjusted odds ratio [aOR], 1.38), higher Charlson Comorbidity Index (per 1-SD increase, aOR, 1.27), higher Sequential Organ Failure Assessment score (per 1-SD increase, aOR, 1.41), intensive care unit admission (aOR, 1.47), and pulmonary infection (aOR, 1.77) were associated after adjustment with new-onset frailty (all p < 0.001). Several of these factors were also associated with in-hospital death, with a larger adjusted estimate for SOFA score. Among hospital survivors with new-onset frailty, 42.8% were discharged home. In exploratory analyses restricted to patients with new-onset frailty, higher Sequential Organ Failure Assessment score, solid malignancy, and nursing home- or nursing hospital-acquired infection were associated with a lower likelihood of home discharge. In sensitivity analyses using inverse probability of censoring weighting, the overall pattern of associations for new-onset frailty remained generally consistent.
New-onset frailty and in-hospital death were common among patients with sepsis who were non-frail at baseline. Assessment of frailty at admission and discharge may help characterize functional decline and inform discharge planning after sepsis.

PMID:
42443994
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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