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ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Authors :
Raphael Romano Bruno
Bernhard Wernly
Behrooz Mamandipoor
Richard Rezar
Stephan Binnebössel
Philipp Heinrich Baldia
Georg Wolff
Malte Kelm
Bertrand Guidet
Dylan W. De Lange
Daniel Dankl
Andreas Koköfer
Thomas Danninger
Wojciech Szczeklik
Sviri Sigal
Peter Vernon van Heerden
Michael Beil
Jesper Fjølner
Susannah Leaver
Hans Flaatten
Venet Osmani
Christian Jung
Source :
Frontiers in Medicine, Vol 8 (2021)
Publication Year :
2021
Publisher :
Frontiers Media S.A., 2021.

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.

Details

Language :
English
ISSN :
2296858X
Volume :
8
Database :
Directory of Open Access Journals
Journal :
Frontiers in Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.91db84d13edb4cb8a136e0c5cc7f8551
Document Type :
article
Full Text :
https://doi.org/10.3389/fmed.2021.697884