Tree-based, two-stage risk factor analysis for postoperative sepsis based on Sepsis-3 criteria in elderly patients: A retrospective cohort study

Abstract

BackgroundSepsis remains the leading cause of postoperative death in elderly patients and is defined as organ dysfunction with proven or suspected infection according to Sepsis-3 criteria. To better avoid potential non-linear associations between the risk factors, we firstly used a tree-based analytic methods to explore the putative risk factors of geriatric sepsis based on the criteria in the study.MethodsData of 7,302 surgical patients aged ≥ 65 years at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2020 were collected. An analytic method that combined tree-based analysis with the method of Mantel-Haenszel and logistic regression was adopted to assess the association between 17 putative risk factors and postoperative sepsis defined by the Sepsis-3 guideline by controlling 16 potential confounding factors.ResultsAmong the 16 potential covariates, six major confounders were statistically identified by the tree-based model, including cerebrovascular diseases, preoperative infusion of red blood cells, pneumonia, age ≥ 75, malignant tumor and diabetes. Our analysis indicated that emergency surgery increases the risk of postoperative sepsis in elderly patients by more than six times. The type of surgery is also a crucial risk factor for sepsis, particularly transplantation and neurosurgery. Other risk factors were duration of surgery > 120 min, administration of steroids, hypoalbuminemia, elevated creatinine, blood urea nitrogen, hematocrit, platelets, glucose, white blood cell count, abnormal neutrophil-to-lymphocyte ratio and elevated hsCRP-to-albumin ratio.ConclusionsOur study uses an effective method to explore some risk factors for postoperative sepsis in elderly by adjusting many potential confounders and it can provide information for intervention design.

The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study

“…There was study showed an overall mortality of 27% in post-traumatic AKI was comparable with what had been observed in a general ICU population [ 29 ]. Emergency surgery increased the risk of postoperative sepsis over 6-fold after regarding the confounders in aged patients [ 30 ]. Some studies in patients developing AKI after cardiac surgery showed short-term mortality of cardiac surgery-associated AKI (CSA-AKI) was reported between 15–30% [ 31 ].…”

Causal pathway from telomere length to occurrence and 28-day mortality of sepsis: an observational and mendelian randomization study

“…Susceptibility to infection arises from immune aging [ 31 ]. In a prospective cohort study, a large proportion of elderly patients with severe infections had higher inflammatory protein abundance and lower lymphocyte counts [ 32 ]; in a retrospective cohort study on the analysis of risk factors for postoperative sepsis in elderly patients, an abnormal neutrophil-to-lymphocyte ratio was clearly identified as a risk factor [ 33 ]. The above findings corroborate the presence of immune senescence.…”