Abstract
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.
Highlights
Sepsis is common and is associated with a high morbidity and mortality [1,2,3,4,5]
Very old patients suffered from urinary tract infections significantly more frequently [1,490 (24%) vs. 887 (28%), p < 0.001], but significantly less from skin infections [477 (8%) vs. 160 (5%), p < 0.001]
The proportion of African Americans was higher in the old patients [540 (9%) vs. 204 (6%), p < 0.001], while the proportion of Hispanics was greater in the very old patients [193 (3%) vs. 149 (5%), p < 0.001]
Summary
Sepsis is common and is associated with a high morbidity and mortality [1,2,3,4,5]. During the last two decades, improvements in intensive care therapy have lowered the mortality from sepsis. Critically ill old (>64 years), and very old (>79 years) patients are more at risk, with older patients developing sepsis more frequently and with greater severity [6, 7] This risk is of great importance for intensive care medicine as old and very old patients are among the fastest-growing subgroups of all patients admitted to the intensive care unit (ICU) [8]. On one hand intensive care medicine is associated with high costs, additional suffering due to invasive procedures and a loss of dignity but on the other hand, intensive care triage based on chronological age alone has been heavily criticized [13,14,15]
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