SEPTIC SHOCK OUTCOMES IN ELDERLY CRITICALLY ILL PATIENTS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Sepsis is a common cause of admission to the ICU and is considered a major cause of morbidity and mortality. Among all ICU admissions, elderly patients contribute a high percentage of admissions. Very few studies have explored outcomes and mortality rates among the elderly population with sepsis. This study is designed to answer the question if age is an independent risk factor for mortality, ICU and hospital length of stay(LOS), use and duration of mechanical ventilation(MV), and discharge outcome in critically ill, elderly patients that present to the ICU. METHODS: A retrospective, observational chart review of all patients ≥65 years admitted to the ICU from 01/01/2017 to 12/31/2017 at The Brooklyn Hospital Center was conducted. We collected demographics, BMI, admission diagnosis, comorbidities, vasopressor use, steroid use, and APACHE II score at the time of ICU presentation. Patients with non-septic shock diagnosis were excluded from the study. In-hospital mortality was the primary outcome. ICU and hospital LOS, need and duration of MV, vasopressor requirement and discharge outcomes were secondary outcomes of the study. RESULTS: Out of 595 elderly ICU admissions, 173 presented with septic shock. The average age for septic patients was 79.40 years and average BMI was 25.9 kg/m2. The mean APACHE II score was 26, average ICU LOS and hospital LOS was 7.25 and 15.26 days respectively. Out of 173 patients, 50.29 % developed acute respiratory failure with 30.06% requiring MV for average of 8.1 days, 68.79% required Vasopressors, overall mortality rate was 30.64%. Logistic regression showed that age was not a significant independent risk factor for mortality (OR, 1.029; 95% CI, 0.988-1.071) in septic patients admitted to the ICU. Age was also not a significant risk factor for ICU and hospital LOS, MV use and duration, and vasopressor requirement. Among all survivors, 23.97% were discharged home, 41.32% to Nursing home, 22.31 % were placed in hospice and 12.4% had tracheostomy/PEG tube placement. Logistic regression also showed that age was a significant factor in discharge outcome in that older patients were less likely to be discharged home (OR, 1.059; 95% CI, 1.003-1.120). CONCLUSIONS: Our study showed that among elderly septic survivors, less than 24% were discharged home with a worsening trend as pts get older. This study demonstrated that advanced age among critically ill patients with septic shock is not a risk factor for mortality, need for MV and vasopressor requirement but is a significant contributor to morbidity. CLINICAL IMPLICATIONS: Advanced age among critically ill patients with septic shock contributes to increased morbidity and poorer discharge outcome. DISCLOSURES: No relevant relationships by Mona Alipour, source=Web Response No relevant relationships by Khoi Paul Dang-Ho, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response