Septic shock in older people: a prospective cohort study

Silva, Fabiano Pinheiro da; Zampieri, Fernando Godinho; Barbeiro, Denise Frediani; Barbeiro, Hermes Vieira; Goulart, Alessandra Carvalho; Filho, Francisco Torggler; Velasco, Irineu Tadeu; Neto, Luiz Monteiro da Cruz; Souza, Heraldo Possolo de; Machado, Marcel Cerqueira César

doi:10.1186/1742-4933-10-21

Cited by 17 publications

(19 citation statements)

References 28 publications

(27 reference statements)

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“…Alternatively, the PSI score may less accurately reflect CAP severity in very old patients. Our results are supported by a study conducted in the ICU, reporting no differences in a large set of cytokines and chemokines between older and younger patients with septic shock at admission [21].…”

Section: Discussionsupporting

confidence: 87%

The effect of age on the systemic inflammatory response in patients with community-acquired pneumonia

Vught

Endeman

Meijvis

et al. 2014

Clinical Microbiology and Infection

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Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Increasing age has been associated with elevated circulating levels of pro-inflammatory mediators. We aimed to determine the impact of ageing on the systemic inflammatory response to CAP. In total 201 CAP patients were enrolled. Blood samples were obtained upon presentation, and on days 2, 3 and 5. For the current analysis patients≤50 and ≥80 years were included. The Pneumonia Severity Index (PSI) score was calculated at presentation. The study encompassed 46 CAP patients aged ≤50 years (median 37 years) and 41 CAP patients aged ≥80 years (median 84 years). In both groups Streptococcus pneumoniae was the common causative microorganism. Whereas most young patients had a PSI score of I (54%), 98% of elderly patients had a PSI score≥III (p<0.001). Four elderly patients died vs. none of the young patients (p 0.045). Older patients demonstrated lower serum C-reactive protein levels on admission and during the course of their hospitalization (p 0.001) in spite of more severe disease. Serum concentrations of pro-inflammatory (interleukin (IL)-6 and IL-8) and anti-inflammatory cytokines (IL-10 and IL-1 receptor antagonist) did not differ between age groups, although admission IL-8 levels tended to be higher in elderly patients (p 0.05). Cytokine levels were positively correlated with PSI in young but not in elderly patients. These results suggest that elderly patients show an absolute (C-reactive protein) or relative (cytokines) reduction in their systemic inflammatory response on admission for CAP.

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Section: Discussionsupporting

confidence: 87%

The effect of age on the systemic inflammatory response in patients with community-acquired pneumonia

Vught

Endeman

Meijvis

et al. 2014

Clinical Microbiology and Infection

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“…Animal studies demonstrated that mortality, inflammation, hypothermia, apoptosis and disseminated intravascular coagulation are increased in aged animals subjected to experimental models of sepsis [ 21 ]. It is intriguing that despite the well characterized aspects of immunosenescence and the exaggerated inflammatory response detected in septic aged rodents [ 22 , 23 ], clinical studies conducted in humans (including those from our group) observed a similar immune profile when old and young septic critically ill patients were compared [ 24 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Septic Shock in Advanced Age: Transcriptome Analysis Reveals Altered Molecular Signatures in Neutrophil Granulocytes

et al. 2015

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Sepsis is one of the highest causes of mortality in hospitalized people and a common complication in both surgical and clinical patients admitted to hospital for non-infectious reasons. Sepsis is especially common in older people and its incidence is likely to increase substantially as a population ages. Despite its increased prevalence and mortality in older people, immune responses in the elderly during septic shock appear similar to that in younger patients. The purpose of this study was to conduct a genome-wide gene expression analysis of circulating neutrophils from old and young septic patients to better understand how aged individuals respond to severe infectious insult. We detected several genes whose expression could be used to differentiate immune responses of the elderly from those of young people, including genes related to oxidative phosphorylation, mitochondrial dysfunction and TGF-β signaling, among others. Our results identify major molecular pathways that are particularly affected in the elderly during sepsis, which might have a pivotal role in worsening clinical outcomes compared with young people with sepsis.

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“…Indeed, 60% of all sepsis events and 80% of septic deaths occur in individuals over 65 years-old [26]. The incidence increases exponentially with age and older age is an independent risk factor for mortality among adults hospitalized with sepsis [26]. Elderly patients are particularly exposed to the risk of nosocomial infections [27].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses

Nechba¹

2013

SJPH

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Objectives: This study was made to identify the epidemiological data of elderly patients (over 65 years of age) vs. younger patients (< 65 years) requiring admission to the intensive care unit for severs medical illnesses. Design and patients: We conducted an analysis of a prospective observational study of 106 adults admitted to the intensive care unit for severs medical illnesses, from January 2010 to January 2012. Patients admitted to the intensive care unit for surgical illnesses were excluded. Setting: A 6-bed polyvalent intensive care unit in a regional hospital. Results: The study group included 31(29%) elderly patients (≥65 years of age) and 75 (71%) young patients (<65 years of age) (n=106). Elderly patients tended to have a higher simplified acute physiology score version II in admission (36 vs 21, p<0,001). There were several epidemiological differences between the two groups: Chronic diseases were more frequent in elderly patients than in younger one (diabetes (55% vs 20%; p<0,001), high blood pressure (45% vs 13%; p<0,001) and heart diseases (48% vs 19%; p=0,002). Elderly patients were significantly more hospitalized for delirium comparing to younger one (87% vs 64%; p=0,017), but dyspnea was less percepted by elderly patients 29% vs 55% for younger patients, p=0,016. Acute respiratory distress syndrome, acute heart failure, acute kidney injury, were all more frequent in elderly patients respectively (p= 0,006, p=0,014, p=0,005). The incidence of death was 37% for all patients and it was similar between the two groups (p=0,251). Conclusion: The identification of epidemiology of older patients hospitalized in intensive care unit for severs medical illnesses will help to develop qualified practice. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of complications.

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Septic shock in older people: a prospective cohort study

Cited by 17 publications

References 28 publications

The effect of age on the systemic inflammatory response in patients with community-acquired pneumonia

The effect of age on the systemic inflammatory response in patients with community-acquired pneumonia

Septic Shock in Advanced Age: Transcriptome Analysis Reveals Altered Molecular Signatures in Neutrophil Granulocytes

Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses

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