Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country

Abstract

Background This study aimed to determine the prevalence of infectious diseases and risk factors for one-year mortality in elderly emergency department (ED) patients. Methods A retrospective cohort study of patients aged 65 and over who visited the ED of one urban teaching hospital in Bangkok, Thailand and who were diagnosed with infectious diseases between 1 January 2016 and 30 June 2016. Results There were 463 elderly patients who visited ED with infectious diseases, accounting for 14.5% (463/3,196) of all elderly patients’ visits. The most common diseases diagnosed by emergency physicians (EPs) were pneumonia [151 (32.6%) patients] followed by pyelonephritis [107 (23.1%) patients] and intestinal infection [53 (11.4%) patients]. Moreover, 286 (61.8%) patients were admitted during the study period. The in-hospital mortality rate was 22.7%. 181 (39.1%) patients died within 1 year. Our multivariate analysis showed that age 85 years and older [odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.36–2.63], Charlson Co-morbidity Index score ≥ 5 (OR = 3.51; 95% CI2.14–5.77), lactate ≥4 mmol/l (OR = 2.66;95% CI 1.32–5.38), quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (OR = 5.46; 95% CI 2.94–10.12), and platelet count < 100,000 cells/mm 3 (OR = 3.19; 95% CI 1.15–8.83) were associated with 1-year mortality. Conclusions In one middle-income country, infectious diseases account for 14.5% of elderly ED patients. Almost two-thirds of patients presenting to ED with infection are admitted to hospital. One-third of elderly ED patients with infection died within 1 year. Age ≥ 85 years, Charlson Co-morbidity Index score ≥ 5, lactate ≥4 mmol/l, qSOFA score ≥ 2, and platelet count < 100,000 cells/mm 3 predicted 1-year mortality rate.

Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital – A single-center registry

“…[ 12 ] from Singapore has also reported on similar lines. Further, a study from Thailand conducted over a 6-month period reported that 32.6% of all elderly (aged 65 years and above) ED mortality due to infectious diseases was diagnosed as pneumonia,[ 13 ] thus corroborating the results of our study. Even the nationwide statistics in India suggests that the mortality due to lower respiratory tract infection in elderly aged 70 years and above has increased by 83.4% in the year 2016 when compared to 2000.…”

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

“…One small retrospective study showed lower mortality among sepsis patients enrolled than those not enrolled in the SFT (21% vs 43%) at the study hospital, 13 while another study did not find an association between SFT and mortality outcome. 14 These studies were subject to selection biases due to their retrospective nature. 13 14 Interventional studies to randomise patients to receive or not receive the SFT, however, would be unethical and impractical after the national recommendations have been implemented.…”

Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006–2017

“…Age-related physiological changes place the elderly at high risk for infectious diseases due to a combination of factors, including immune senescence, altered skin and mucosal barrier function, degenerative changes in bone and cartilage, as well as a reduction in respiratory capacity [7][8][9]. In addition, infectious diseases are a leading cause of hospital admission and death in this patient population [10].…”