Abstract
Objective To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients.Methods Retrospective cohort study including 848 severe sepsis and septic shock patients admitted to the intensive care unit between January 2006 and March 2012.Results Elderly patients accounted for 62.6% (531/848) and non-elderly patients for 37.4% (317/848). Elderly patients had a higher APACHE II score [22 (18-28) versus 19 (15-24); p<0.001], compared to non-elderly patients, although the number of organ dysfunctions did not differ between the groups. No significant differences were found in 28-day and in-hospital mortality rates between elderly and non-elderly patients. The length of hospital stay was higher in elderly compared to non-elderly patients admitted with severe sepsis and septic shock [18 (10-41) versus 14 (8-29) days, respectively; p=0.0001]. Predictors of death among elderly patients included age, site of diagnosis, APACHE II score, need for mechanical ventilation and vasopressors.Conclusion In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary.
Highlights
Severe sepsis and septic shock are major reasons for intensive care unit (ICU) admission worldwide and they are associated with high morbidity and mortality rates, despite intense efforts towards early diagnosis and treatment.[1,2,3]Rivers et al[4] proposed the concept of early goaldirected therapy for the treatment of severe sepsis and septic shock patients in 2001
The number of elderly patients with severe sepsis and septic shock has been increasing steadily.[7]. This population of elderly patients is characterized by an increased prevalence of chronic illness, comorbidities, frailty and functional impairment.[8,9] while recent evidence has demonstrated that elderly patients submitted to complex therapeutic interventions during hospitalization showed benefits in long-term survival,(10) observational studies have shown that increased age is an independent predictor of death among septic and non-septic patients.[11,12,13]
Patients According to the institutional protocol for severe sepsis and septic shock resuscitation, all patients admitted to the emergency department or those in hospital who had been seen by the rapid response team and fulfilled the criteria for severe sepsis and septic shock were admitted to the ICU
Summary
Rivers et al[4] proposed the concept of early goaldirected therapy for the treatment of severe sepsis and septic shock patients in 2001. This principle has been incorporated in the Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock.[5] early identification, broad spectrum antibiotic administration and hemodynamic stabilization have been the cornerstone of severe sepsis and septic shock management.[6]. We postulated that elderly patients with severe sepsis or septic shock resuscitated following the Surviving Sepsis Campaign Guidelines have similar short-term mortality rates when compared to non-elderly patients with severe sepsis or septic shock This population of elderly patients is characterized by an increased prevalence of chronic illness, comorbidities, frailty and functional impairment.[8,9] while recent evidence has demonstrated that elderly patients submitted to complex therapeutic interventions during hospitalization showed benefits in long-term survival,(10) observational studies have shown that increased age is an independent predictor of death among septic and non-septic patients.[11,12,13]
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