Postintensive Care Frailty of Older Patients With Septic Shock: A Post Hoc Analysis of a Multicenter Randomized Controlled Trial
In brief
Corticosteroids increase severe post-ICU frailty by roughly 70% in older septic shock survivors
In a post-hoc analysis of 339 patients aged 65 or older who survived septic shock, one-third were severely frail at 90 days. Higher pre-sepsis frailty, greater organ failure scores, and use of corticosteroids each independently predicted worse frailty, with steroids raising the odds of severe frailty by about 70%. The findings suggest careful steroid use may be needed, but causal links remain uncertain.
- Journal
- Critical care medicine (Q1)
- Published
- 12 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ryo Yamamoto, Takahiro Yamanaka, Daiki Kaito, Akia Endo, Kazuma Yamakawa, Takashi Tagami, et al.
- PMID
- 42584186
- DOI
- 10.1097/CCM.0000000000007304
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 16 August 2026): Post‑ICU frailty after septic shock in older adults
Abstract
OBJECTIVES: Postintensive care frailty impairs quality of life in survivors of severe illness. While anabolic hormone deficiency and prolonged inflammation are considered key physiologic mechanisms, specific features associated with frailty progression remain unclear. This study aimed to elucidate clinical characteristics associated with frailty deterioration following recovery from septic shock in older adults. DESIGN: Post hoc analysis of a randomized controlled trial. SETTING: ICUs in Japan. PATIENTS: Adults of 65 years or older with septic shock. MEASUREMENTS AND MAIN RESULTS: Data were analyzed from a randomized controlled trial investigating optimal blood pressure targets in patients of 65 years or older with septic shock. Frailty at 90 days after intensive care was classified as no-to-mild, moderate, and severe based on the Clinical Frailty Scale (CFS) scores of less than or equal to 4, 5-6, and greater than or equal to 7, respectively. Baseline characteristics, treatments, and outcomes were compared across these frailty categories. Factors associated with postintensive care frailty were identified using ordinal logistic regression fitted with a generalized estimating equation model. Among 513 eligible patients, 339 patients survived to 90 days; 103 patients (30.4%) had no-to-mild frailty, 114 patients (33.6%) had moderate frailty, and 122 patients (36.0%) had severe frailty, respectively. Higher presepsis CFS scores (adjusted odds ratio [aOR], 2.03 [1.72-2.40] per 1-point increase; p < 0.001), higher sequential organ failure assessment (SOFA) scores (aOR, 1.16 [1.06-1.26] per 1-point increase; p < 0.001), and corticosteroid use (aOR, 1.72 [1.14-2.61]; p < 0.001) were independently associated with frailty. Subgroup analyses revealed that corticosteroid use was associated with frailty deterioration in patients with baseline frailty (CFS ≥ 5), whereas SOFA scores were associated with frailty in patients with tissue hypoperfusion (lactate, ≥ 2 mmol/L). CONCLUSIONS: Baseline frailty before sepsis, organ dysfunction severity, and corticosteroid therapy independently predict severe postintensive care frailty in older adults with septic shock.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.