Frailty, organ dysfunction and mortality in older ICU patients

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.

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Journal
Scientific Reports
Published
2026-08-25
DOI
https://doi.org/10.1038/s41598-026-68534-2
Primary Topic
Frailty in Older Adults
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article
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article

Frailty, organ dysfunction and mortality in older ICU patients

Sevda Onuk, Eylem Tunçay, Şeyma Tunç, Ayşegül Tomruk Erdem et al.
Scientific Reports
Frailty in Older Adults
article

Frailty, organ dysfunction and mortality in older ICU patients

Sevda Onuk, Eylem Tunçay, Şeyma Tunç, Ayşegül Tomruk Erdem, Hüseyin Özkök, Nilgün Savaş, Sinem Güngör, Şeyma Başlılar, Gül Erdal Dönmez, Volkan İnal, Ayşen Kara, Seda Banu Akıncı, Ömer Tamer Doğan, Nalan Demir, Kaniye Aydın, Sait Karakurt, Demet Polat Yuluğ, Gözde Öksüzler Kizilbay, Selçuk Yaylacı, Umut Sabri Kasapoğlu, Neslihan Taş, Nazli Hüma Teke, Emre Aydın, Mehmet Gökhan Gök, Seher Yanatma, Deniz Çelik, Mehmet Süleyman Sabaz, Oğuzhan Kayhan, Öner Balbay, Ayşe Çapar, Ahmet Uysal, Banu Kılıçaslan, Yeşim Şerife Bayraktar, Ahmet Oğuzhan Küçük, Gülçin Hilal Alay, Feyzullah Kolay, Berkay Küçük, Korhan Kollu, Veysi Tekin, Nesrin Öcal, Fatma Yılmaz Aydın, Ayşen Erer, Eda Macit Aydın, Ferhan Demirer Aydemir, Erdem Yalçınkaya, Esra Çankaya, Eren Mingsar, Buket Mermit, Hande Çelik, Büşra Nur Akdağ, Burcu Öztürk, Kamuran Uluç, Leman Acun Delen, Esra Nurlu Temel, Arife Polat Düzgün, Aslı Melek Savaş, Mücahid Çolak8, Mahmut Baran Kasisari, Alkım Gizem Yılmaz Selimoğlu, Rezan Serefoglu, Hamza Gultekin, Ozkan Yetkin, Ahmet Yurttas, Seda Seven Inci, Huseyin Coskuner, Pervin Hanci Yilmazturk, Hicran Kocak, Nur Kasimoglu, Lutfiye Serap Avlagi, Hatice Arzu Ucar, Huseyin Lakadamyali, Leyla Saglam, Duygu Ozdemir Simsek, Ugur Altun, Eylem Sercan Ozgur, Dilek Özcengiz, İsmail Yıldız, Melike Bektas, Dursun Ali Saglam, Yusuf Aydemir, Cemile Altın, Murat Bicakcioglu, Oktay Demirkiran, Huseyin Arikan, Pınar Ozgun, Omer Dogan, Ozlem Yazicioglu Mocin, Kamil Gonderen, Gulsum Altuntas, Sinem Iliaz, Ozlem Ediboglu, Beyza Yuksel, Elvan Senturk Topaloglu, Baris Yilmaz, Ayse Belin Ozer, Zerrin Ozcelik, Fethi Gul, Yasemin Cebeci, Esra Tekin, Faruk Yildiz
article en

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.

Scientific Reports
Sakarya University (TR), Van Yüzüncü Yıl Üniversitesi (TR), Dicle University (TR), Trakya University (TR), Sivas Cumhuriyet Üniversitesi (TR), Izmir University (TR), Selçuk University (TR), Fırat University (TR), Recep Tayyip Erdoğan University (TR), Karadeniz Technical University (TR), University of Health Science (KH), Inonu University (TR), Tokat Gaziosmanpaşa Üniversitesi (TR), Izmir Kâtip Çelebi University (TR), State Hospital (GB), Zonguldak Bülent Ecevit University (TR), Konya Numune Hastanesi (TR), Gülhane Askerî Tıp Akademisi (TR), Canakkale Onsekiz Mart Universitesi Tip Fakultesi Hastanesi (TR), Ankara Atatürk Eğitim ve Araştırma Hastanesi (TR), Memorial Ankara Hospital (TR), Biruni University (TR), Sivas State Hospital (TR), Malatya Turgut Özal Üniversitesi (TR), Istanbul University-Cerrahpaşa (TR), Alanya University (TR), Erzurum Regional Training and Research Hospital (TR), Konya Eğitim ve Araştırma Hastanesi (TR), Kayseri Eğitim ve Araştırma Hastanesi (TR), Başkent University Hospital (TR), Sağlık Bilimleri Üniversitesi (TR), Universidad CES (CO), Sema Hospital (TR), Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi (TR), Izmir Atatürk Eğitim ve Araştırma Hastanesi (TR), Department of Public Health (MM), Türk Anesteziyoloji ve Reanimasyon Derneği (TR), Mersin Üniversitesi (TR), Düzce Üniversitesi (TR), Cukurova University (TR), Atatürk University (TR), Turgut Özal University (TR), Hacettepe University (TR), Marmara University (TR), Adnan Menderes University (TR), University of Health Sciences Antigua (AG), Kastamonu University (TR)
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Frailty in Older Adults
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