Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study

Martín‐Loeches, Ignacio; Guia, Maria Consuelo; Vallecoccia, Maria Sole; Suarez, David L.; Ibarz, Mercedes; Irazábal, Marián; Ferrer, Ricard; Artigas, Antonio

doi:10.1186/s13613-019-0495-x

Cited by 136 publications

(141 citation statements)

References 26 publications

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“…Life sustaining treatment limitations in older subjects before the decision to admit patients to intensive care unit might further explain different results, since physicians might be reluctant to admit old patients to ICU despite proper admission criteria [24]. In our study patients admitted to ICU were 4%, with 1.5% over 80 years, and 1% over 90 years, a different result in comparison to 8.8% of cases, with only 0.4% over 90 years in a recent study [16]: this selection bias might explain part of inequalities of subjects included in different studies.…”

Section: Discussioncontrasting

confidence: 81%

“…The incidence of sepsis has been reported to increase with age, mainly due to a sharp incidence in the group of subjects aged ≥80 [5], with high mortality rate [13][14][15]. In a recent large study nearly two thirds of patients admitted for sepsis were aged 65 or older [16] with age clearly associated with the development of sepsis. Our data probably reflect the peculiar Italian demography, with 84% of our patients over 65 and 53% over 80.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study a group of variables, i.e. age, the modified APACHE II score, ICU length of stay, patient location at sepsis diagnosis and coagulopathy were indicated as main outcome predictors [16]; in another study the selected variables entering the logistic model were only those associated with immediate fatality conditions, severity score or condition warranting intensive care admission and frailty, but not age [21,22].…”

Section: Discussionmentioning

confidence: 99%

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Old subjects with sepsis: trend analysis of case fatality rate in the Emergency Department

Fabbri

Marchesini

Benazzi

et al. 2019

Preprint

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Background The burden of sepsis represents a global health care problem. We aimed to assess the case fatality rate (CFR) and its predictors in subjects with sepsis admitted to a general Italian hospital from 2009 to 2016, stratified by risk score. Methods We performed a retrospective analysis of all sepsis-related hospitalizations after Emergency Department (ED) visit in a public Italian hospital in an 8-year period. A risk score to predict CFR was computed by logistic regression analysis of selected variables in a training set (2009-2012), and then confirmed in the whole study population. A trend analysis of CFR during the study period was performed dividing patient as high-risk (upper tertile of risk score) or low-risk . Results 2,492 subjects were included. Over time the incidental admission rate (no. of sepsis-related admissions per 100 total admissions) increased from 4.1% (2009-2010) to 5.4% (2015-2016); P<0.001, accompanied by a reduced CFR (from 38.0% to 18.4%; P<0.001). A group of 10 variables (admission in intensive care unit, cardio-vascular dysfunction, HIV infection, diabetes, age ≥80 years, respiratory diseases, number of organ dysfunction, digestive diseases, dementia and cancer) were selected by the logistic model to predict CFR with good accuracy: AUC 0.873 [0.009]. Along the years CFR decreased from 31.8% (2009-2010) to 25.0% (2015-2016); P = 0.007. The relative proportion of subjects ≥80 years (overall, 52.9% of cases) and classified as high-risk did not change along the years. CFR decreased only in low-risk subjects (from 13.3% to 5.2%; P<0.001), and particularly in those aged ≥80 (from 18.2% to 6.6%; P=0.003), but not in high-risk individuals (from 69.9% to 64.2%; P=0.713). Conclusion Between 2009 and 2016 the incidence of sepsis-related hospitalization increased in a general Italian hospital, with a downward trend in CFR, only limited to low-risk patients and particularly to subjects ≥80 years.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Old subjects with sepsis: trend analysis of case fatality rate in the Emergency Department

Fabbri

Marchesini

Benazzi

et al. 2019

Preprint

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“…Therefore, the world population is progressively getting older. The admission of elderly and very elderly patients to the intensive care unit (ICU) has increased in developed countries (1). The short-term outcomes after ICU may be associated with illness severity, comorbidities, performance status of the patient and the quality of care.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Cost and Factors Affecting Mortality in Elderly Patients in the Intensive Care Unit

Irmak¹,

Adıgüzel²,

Tunçay³

et al. 2020

tjgeri

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The older population of the world continues to grow. Currently, 8.5% of people worldwide are above 65 years, leading to an increased frequency of intensive care unit admission. This study aimed to assess the cost and factors affecting mortality in elderly patients. Materials and Methods: This retrospective cohort study included patients aged over 65 years admitted to the tertiary intensive care unit. The demographics including age, gender, body mass index, comorbidities, Glasgow coma scale scores, acute physiology and chronic health evaluation II, the Charlson comorbidity index scores, diagnosis, blood gas analysis results, type of mechanical ventilation, length of stay in the intensive care unit (ICU), time of death and cost of ICU stay were obtained from the government electronic mortality declaration system. Results: This study evaluated 1401 patients with a mean age of 75.73 ± 6.92, where the mean BMI was 25.31 ± 7.03. Most of the patients (n=714, 51%) belonged to the 65-75 years old group while 569 (40.6%) belonged to the 75-85 years old group and 118 (8.4%) were over 85 years old. Mortality rates were the following: 28-day mortality rate, 41.7%; 1-year mortality rate, 66.4% and 2-year mortality rate, 75%. The mean cost of ICU stay was 7992.95 ± 10166.33 ₺, and the mean cost of hospital stay was 8211.28 ± 10172.41 ₺. Conclusion: It is shown that comorbidities increased as age advanced, and sepsis remains the leading cause of death in short-term and long-term periods in the elderly population admitted to the ICU.

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“…6 Os fatores de risco para mortalidade em idosos descritos na literatura são a idade, especialmente acima de 80 anos; escores de gravidade por ponto, como o Acute Physiology and Chronic Health Evaluation (APACHE II); alteração no nível de consciência; presença de infecção; lesão renal aguda (LRA); pós-operatório, principalmente de cirurgia de urgência; e insuficiência cardíaca aguda. [7][8][9][10] O objetivo deste estudo foi avaliar fatores de risco para mortalidade em pacientes idosos com internação em uma UTI.…”

Section: Introductionunclassified

Fatores de risco para mortalidade em idosos admitidos em unidade de terapia intensiva de hospital público

Bruscagim¹,

Corrêa²,

Ferreira³

et al. 2019

Geriatr., Gerontol. Aging

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OBJETIVO: Avaliar fatores de risco para mortalidade em pacientes idosos com internação em uma unidade de terapia intensiva (UTI). MÉTODOS: Foram estudados pacientes idosos admitidos em UTI, em um estudo de coorte histórica. Foi realizada amostragem de conveniência de todos os pacientes com 60 anos ou mais, internados nos 20 leitos de uma UTI de um hospital de alta complexidade. Foi realizada análise de regressão de Cox para estimar os fatores de risco associados à mortalidade. O nível de significância utilizado foi de 5%. RESULTADOS: A proporção de pacientes idosos representou 45% das admissões em UTI no período. A mortalidade hospitalar foi de 38,4%. A variável pós-operatório de cirurgia de urgência e os escores Acute Physiology and Chronic Health Evaluation (APACHE II) e Sequential Organ Failure Assessment (SOFA) da admissão foram identificados como fatores de risco independentes para mortalidade hospitalar. CONCLUSÃO: Os fatores de risco associados à mortalidade foram os escores APACHE II e SOFA da admissão e pós-operatório de cirurgia de urgência. PALAVRAS-CHAVE: idosos; serviços de saúde para idosos; unidades de terapia intensiva.

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Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study

Cited by 136 publications

References 26 publications

Old subjects with sepsis: trend analysis of case fatality rate in the Emergency Department

Old subjects with sepsis: trend analysis of case fatality rate in the Emergency Department

Retrospective Analysis of Cost and Factors Affecting Mortality in Elderly Patients in the Intensive Care Unit

Fatores de risco para mortalidade em idosos admitidos em unidade de terapia intensiva de hospital público

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