Challenges with Diagnosing and Managing Sepsis in Older Adults

Clifford, Kalin M.; Dy-Boarman, Eliza A.; Haase, Krystal K.; Maxvill, Kristen; Pass, Steven E.; Álvarez, Carlos A.

doi:10.1586/14787210.2016.1135052

Cited by 57 publications

(53 citation statements)

References 67 publications

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“…This may be due to the fact that Sepsis patients include a large proportion of older adults aged 65 years and older. [59][60] We found diabetes mellitus and hypertension increased the risk of AKI, which is consistent with other studies. [61][62][63]66 Chronic kidney disease has been recognized as a significant risk factor for AKI.…”

Section: (1) Risk Factors Of Pre-sepsissupporting

confidence: 92%

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Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Liu

Xie

et al. 2020

Preprint

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Background The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI.Method A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria.Result Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant.Conclusion A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Section: (1) Risk Factors Of Pre-sepsissupporting

confidence: 92%

“…1 Moreover, With the global aging trend, and the majority of sepsis patients are mainly elderly, the number of patients with sepsis-induced AKI may continue to increase. [6][7] Sepsis-associated AKI portends a high burden of morbidity and mortality in both children and adults with critical illness.…”

Section: Introductionmentioning

confidence: 99%

Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Liu

Xie

et al. 2020

Preprint

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show abstract

“…This may be due to the fact that majority of the sepsis patients were older adults aged 65 years and older. [59][60] We found diabetes mellitus and hypertension were associated with higher risks of AKI, which is consistent with other studies. [61][62][63]66 Chronic kidney disease has been recognized as a signi cant risk factor for AKI.…”

Section: Pre-sepsis Risk Factorssupporting

confidence: 91%

“…1 Moreover, along with the global aging trend, majority of the sepsis patients were elderly, and the number of patients with sepsis-associated AKI may continue to increase. [6][7] Sepsis-associated AKI portends a high burden of morbidity and mortality in both children and adults with critical illness. Unfortunately, the pathogenesis of S-AKI is still not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Liu

Xie

et al. 2020

Preprint

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Background: Due to the high incidence and mortality of sepsis-associated acute kidney injury, a significant number of studies have explored the causes of sepsis-associated acute kidney injury (AKI). However, the opinions on relevant predictive risk factors remain inconclusive. This study aimed to provide a systematic review and a meta-analysis to determine the predisposing factors for sepsis-associated AKI.Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed, and Web of Science, databases, with an end-date of 25th May 2019. Valid data were retrieved in compliance with specific inclusion and exclusion criteria.Result: Forty-seven observational studies were included for analysis, achieving a cumulative patient number of 55,911. The highest incidence of AKI was caused by septic shock. Thirty-one potential risk factors were included in the meta-analysis. Analysis showed that 20 factors were statistically significant. The odds ratio (OR) and 95% confidence interval (CI), as well as the prevalence of the most frequently-seen predisposing factors for sepsis-associated AKI, were as follows: septic shock [2.88 (2.36-3.52), 60.47%], hypertension [1.43 (1.20-1.70), 38.39%], diabetes mellitus [1.59 (1.47-1.71), 27.57%], abdominal infection [1.44 (1.32-1.58), 30.87%], the administration of vasopressors [2.95 (1.67-5.22), 64.61%], the administration of vasoactive drugs [3.85 (1.89-7.87), 63.22%], mechanical ventilation [1.64 (1.24-2.16), 68.00%], positive results from blood culture [1.60 (1.35-1.89), 41.19%], and a history of smoking [1.60 (1.09-2.36), 43.09%]. Other risk factors included cardiovascular diseases, coronary artery diseases, liver diseases, unknown infections, the administration of diuretics and ACEI/ARB, infection caused by gram-negative bacteria, and organ transplantation.Conclusion: Risk factors of S-AKI arise from a wide range of sources, making it difficult to predict and prevent this condition. Comorbidities, and certain drugs, are the main risk factors for S-AKI. Our review can provide guidance on the application of interventions to reduce the risks associated with sepsis-associated acute kidney injury and can also be used to tailor patient-specific treatment plans and management strategies in clinical practice.

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“…Age-related changes in the immune system, otherwise known as immunosenescence, increase the vulnerability of the older adult to infection while decreasing his or her immune response 45,46. Although aging is crucial in sepsis, the impacts of aging on inflammation and immunosuppression remain unclear 47.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury and inflammatory response of sepsis following cecal ligation and puncture in D-galactose-induced aging rats

Liu¹,

Hu²,

Mao³

et al. 2017

CIA

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BackgroundRecently, the d-galactose (d-gal)-induced mimetic aging rat model has been widely used in studies of age-associated diseases, which have shown that chronic d-gal exposure induces premature aging similar to natural aging in rats. With the increasing rate of sepsis in the geriatric population, an easy-access animal model for preclinical studies of elderly sepsis is urgently needed. This study investigates whether a sepsis model that is established in d-gal-induced aging rats can serve as a suitable model for preclinical studies of elderly patients with sepsis.ObjectiveTo investigate the acute kidney injury (AKI) and inflammatory response of sepsis following cecal ligation and puncture (CLP) in d-gal-induced aging rats.MethodsTwelve-week-old male Sprague Dawley rats were divided into low-dose d-gal (L d-gal, 125 mg/kg/d), high-dose d-gal (H d-gal, 500 mg/kg/d), and control groups. After daily subcutaneous injection of d-gal for 6 weeks, the CLP method was used to establish a sepsis model.ResultsThe mortality was 73.3%, 40%, and 33.3% in the H d-gal, L d-gal, and control groups, respectively. Blood urea nitrogen, creatinine, plasma neutrophil gelatinase-associated lipocalin, interleukin-6, interleukin-10, and tumor necrosis factor-α were markedly increased in the H d-gal group after establishment of the sepsis model (H d-gal vs control, P<0.05 at 12 h and 24 h post-CLP). The rate of severe AKI (RIFLE-F) at 24 h post-CLP was 43% for both the control and L d-gal groups and 80% for the H d-gal group.ConclusionHigh-dose- d-gal-induced aging rats are more likely to die from sepsis than are young rats, and probably this is associated with increased severity of septic AKI and an increased inflammatory response. Therefore, use of the high-dose- d-gal-induced aging rat model of sepsis for preclinical studies can provide more useful information for the treatment of sepsis in elderly patients.

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Challenges with Diagnosing and Managing Sepsis in Older Adults

Cited by 57 publications

References 67 publications

Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

Acute kidney injury and inflammatory response of sepsis following cecal ligation and puncture in D-galactose-induced aging rats

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