Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia

Abstract

Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

“…Importantly, these results confirm observed trends in a recent sub-study of the FROG-ICU study: Hollinger et al reported increased survival rates in moderately elderly women compared to men, whereas in the overall cohort consisting of more than 2000 critically ill patients no sex-related differences in outcomes could be found 13 . These findings, relating male gender to adverse outcomes, are consistent with previous studies reporting adverse outcomes in male septic VIPs 10 . On the other hand, this trend in gender difference was not observed for illness-adjusted mortality in a large Austrian cohort study on 25,998 patients without age-restriction 22 .…”

“…However, some studies investigated gender differences in ICU patients, and have found distinct differences 7 , 8 . Male and female intensive care patients differ with regards to baseline characteristics, risk distribution and admission diagnoses and these differences may influence outcomes 9 , 10 . Male sex was linked to adverse outcomes in a sub-set of VIPs with sepsis 10 , 11 .…”

“…Male and female intensive care patients differ with regards to baseline characteristics, risk distribution and admission diagnoses and these differences may influence outcomes 9 , 10 . Male sex was linked to adverse outcomes in a sub-set of VIPs with sepsis 10 , 11 . On the other hand, female sex was reported to be independently associated with the decision to withdraw or withhold intensive care 12 .…”

Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators

“…In that study, elderly patients, alcohol abusers, patients with renal disease, and COPD patients were found to be more likely to develop sepsis, and S. pneumoniae and mixed etiology were the main causes of severe sepsis. A recent Spanish study [33] investigating the risk and prognostic factors in very old (≥80 years) CAP patients who developed sepsis reported a prevalence of 71% using Sepsis-3 criteria and identified male sex, diabetes mellitus, and chronic renal disease as associated risk factors for sepsis. The mortality rates at 30 days and 1 year were 15% and 30%, respectively.…”

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

“…Published studies have found that age is an independent risk factor for the aspiration pneumonia that commonly occurs with dysphagia (neurovascular and medication induced, such as antipsychotics) [ 20 ]. Likewise, Cilloniz et al [ 21 ] conducted a retrospective observational study and found that among patients with CAP, chronic renal and neurological diseases are both independent risk factors for mortality. Additionally, for patients more than 80 years of age who are hospitalised with CAP, their mortality rates increase if they develop sepsis.…”