Year: 2026
Type: article
Study design: Observational Study
Abstract: Older patients now constitute a large proportion of ICU admissions, yet conventional severity scores may not adequately reflect their specific vulnerabilities. This study examined whether pre-ICU frailty, functional status, comorbidity burden and acute organ dysfunction at ICU admission were associated with 30-day all-cause mortality in patients aged ≥ 65 years, and whether the associations of geriatric vulnerability measures persisted in adjusted models that also included conventional physiology-based severity scores. In this multicentre prospective observational cohort study, 55 ICUs across 27 provinces in Türkiye enrolled consecutive eligible patients aged ≥ 65 years who had an ICU length of stay exceeding 48 h during a 1-month period. Pre-admission frailty and functional status were assessed using the Clinical Frailty Scale (CFS), FRAIL questionnaire and Katz Index of Activities of Daily Living (Katz ADL); comorbidity burden was assessed using the Charlson Comorbidity Index (CCI); and acute illness severity was assessed using the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) and modified Nutrition Risk in the Critically Ill (mNUTRIC) scores. The primary outcome was 30-day all-cause mortality after ICU admission. Kaplan–Meier and Cox regression analyses were framed as conditional 48-h landmark analyses. Follow-up began at the 48-h landmark; observed death times were retained, and all patients alive at day 30 were administratively censored at landmark day 28. A total of 1,529 patients were included (median age, 77 years), and 30-day all-cause mortality was 33.7%. Frailty was common, with 71.2% of patients having a CFS ≥ 5. In the conventional primary Cox model, CFS (aHR 1.190 per one-point increase, 95% CI 1.129–1.255) and SOFA (aHR 1.182 per one-point increase, 95% CI 1.152–1.212) were associated with mortality. In the centre-clustered robust model, CFS (aHR 1.190, 95% CI 1.104–1.283) and SOFA (aHR 1.182, 95% CI 1.143–1.222) remained statistically significant, whereas CCI was estimated with less precision and was not statistically significant (aHR 1.034, 95% CI 0.989–1.081). The extended conventional and centre-clustered robust models including APACHE II yielded the same substantive pattern. Comparisons of organ-support therapies and ICU-acquired complications across vulnerability strata were descriptive and unadjusted. In this selected cohort of ICU patients aged 65 years or older with an ICU length of stay exceeding 48 h, pre-admission frailty and early organ dysfunction showed the most robust associations with 30-day all-cause mortality, whereas chronological age was not independently associated in the adjusted models. These findings should not be interpreted as evidence that chronological age is irrelevant, but rather that frailty and acute organ dysfunction remained associated with mortality after adjustment for chronological age in this cohort.
Source: Scientific Reports
Authors: Umut Sabri Kasapoglu, Ozlem Yazicioglu Mocin, Eylem Tuncay, Sinem Gungor, Huseyin Arikan, Ozlem Ediboglu, Nazlı Huma Teke, Eda Macit Aydın, Berkay Kucuk, Dursun Ali Saglam, Deniz Celik, Ozkan Yetkin, Huseyin Lakadamyali, Ugur Altun, Ahmet Yurttas, Cemile Altın, Baris Yilmaz, Gul Erdal Donmez, Gulcin Hilal Alay, Feyzullah Kolay, Mahmut Baran Kasisari, Rezan Serefoglu, Fethi Gul, Esra Tekin, Hicran Kocak, Mehmet Suleyman Sabaz, Esra Cankaya, Melike Bektas, Seda Seven Inci, Seher Yanatma, Ahmet Duzgun, Leman Acun Delen, Murat Bicakcioglu, Ayse Belin Ozer, Lutfiye Serap Avlagi, Alkim Gizem Yilmaz Selimoglu, Ahmet Oguzhan Kucuk, Duygu Ozdemir Simsek, Banu Kilicaslan, Seda Banu Akinci, Mucahid Colak, Yusuf Aydemir, Gulsum Altuntas, Faruk Yildiz, Volkan Inal, Kaniye Aydin, Mehmet Gokhan Gok, Sevda Onuk, Huseyin Ozkok, Selcuk Yaylaci, Emre Aydın, Fatma Yilmaz Aydin, Omer Dogan, Dilek Ozcengiz, Neslihan Tas, Omer Tamer Dogan, Eren Mingsar, Kamil Gonderen, Ismail Yildiz, Sinem Iliaz, Hatice Arzu Ucar, Ayse Capar, Seyma Baslilar, Yesim Serife Bayraktar, Yasemin Cebeci, Zerrin Ozcelik, Pınar Ozgun, Nilgun Savas, Korhan Kollu, Hamza Gültekin, Aysen Erer, Ferhan Demirer Aydemir, Pervin Hancı Yılmazturk, Ahmet Uysal, Esra Temel, Veysi Tekin, Hande Celik, Aysen Kara, Erdem Yalcinkaya, Sait Karakurt, Buket Mermit, Beyza Yuksel, Busra Nur Akdag, Leyla Saglam, Oner Abidin Balbay, Huseyin Coskuner, Nalan Demir, Seyma Tunc, Nesrin Ocal, Burcu Ozturk Sahin, Elvan Senturk Topaloglu, Eylem Sercan Ozgur, Demet Polat Yulug, Gozde Oksuzler Kizilbay, Oguzhan Kayhan, Oktay Demirkiran, Kamuran Uluc, Nur Kasimoglu, Aysegul Tomruk Erdem, Asli Melek Savas, Serif Kurtulus
Institutions: Marmara University, Sağlık Bilimleri Üniversitesi, HSU Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi, Dicle University, Ankara Etlik City Hospital, Alanya Alaaddin Keykubat Üniversitesi, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Malatya Turgut Özal Üniversitesi, Turgut Özal University, Inonu University, Karadeniz Technical University, Hacettepe University, Sakarya University, Fırat University, Trakya University, Cukurova University, Sivas Cumhuriyet Üniversitesi, Izmir Atatürk Eğitim ve Araştırma Hastanesi, Izmir Kâtip Çelebi University, Biruni University, Adnan Menderes University, Selçuk University, Tokat Gaziosmanpaşa Üniversitesi, Konya City Hospital, Ministry of Health, Van Yüzüncü Yıl Üniversitesi, Atatürk University, Düzce Üniversitesi, Ankara Bilkent City Hospital, Kastamonu Education and Research Hospital, Recep Tayyip Erdoğan University, Mersin Üniversitesi, Istanbul University-Cerrahpaşa, Istanbul University, Zonguldak Bülent Ecevit University, Ankara Atatürk Eğitim ve Araştırma Hastanesi, Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W7204168506
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