Frailty evaluation for the prediction of short-term mortality of patients with sepsis: a meta-analysis

Frailty is increasingly recognized as an important determinant of outcomes in critically ill patients. However, its prognostic value for short-term mortality among adults with sepsis remains incompletely defined. We conducted a meta-analysis to evaluate the association between baseline frailty and short-term mortality in patients with sepsis. PubMed, Embase, and Web of Science were searched for longitudinal observational studies enrolling adult patients with sepsis that compared mortality between frail and non-frail individuals. Frailty was assessed using validated instruments before or at hospital/ICU admission. Short-term mortality was defined as in-hospital or 28-/30-day all-cause mortality. Random-effects models were used to pool risk ratios (RRs) with 95% confidence intervals (CIs) accounting for the potential influence of heterogeneity. Twelve studies involving 14,621 patients with sepsis were included, of whom 4577 (31.3%) were classified as frail at baseline. During follow-up, 3068 (21.0%) patients died. Overall, frailty was associated with a significantly higher risk of short-term mortality (RR 1.82, 95% CI 1.45–2.29, p < 0.001), with substantial heterogeneity (I2 = 83%). The association remained robust across sensitivity analyses and consistent in subgroup analyses stratified by geographic region, study design, sepsis definition, age, sex proportion, frailty assessment scale, outcome type, analytic model, and study quality (all p for subgroup differences > 0.05). Baseline frailty is associated with an approximately 80% higher risk of short-term mortality in adult patients with sepsis. However, the substantial heterogeneity among the included studies warrants cautious interpretation of these findings.