Outcomes of Older Adults with Sepsis at Admission to an Intensive Care Unit
Prior studies have shown that older adults with sepsis have high in-hospital mortality rates; however, less is known about mortality in patients who survive hospitalization. The primary aims of this study were to 1) assess the association of sepsis at ICU admission with clinical outcomes (mortality and decline in functional status) after ICU discharge, and 2) identify other predictors associated with increased mortality and decline in functional status in adults age 60 or older admitted to an ICU.
Prospective cohort study of 309 patients 60 years or older admitted to a medical ICU. Sepsis was defined as 2 of 4 criteria for SIRS: (Temp >38.3 or <36°C, HR>90 beats/min, RR>20 breaths/min or PaCO2 < 32 mmHg 4, WBC>12,000 or <4000 cells/mm3) plus an infection within 2 calendar days before or after admission. Infections were identified using CDC/NHSN definitions for healthcare associated infections. The main outcome measure was time to death within 1 year of ICU admission. The secondary outcome measure was decline in functional status, defined as change in a count of activities of daily living (ADL) from baseline to 1 month after ICU discharge. A Cox proportional hazards model was developed to evaluate sepsis as a predictor for mortality. Multiple linear regression was used to assess factors associated with decline in functional status.
Of the 309 patients, 196 (63%) were defined as having sepsis. Sites of infections are shown in Figure 1. When adjusting for baseline admission covariates, sepsis had a significant impact on survival (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.28-2.52, p = <0.001); however, after adjusting for baseline admission and process covariates (antibiotics and vasopressor use within 48 hrs), the impact of sepsis on survival became non-significant (HR 1.26, CI 0.87-1.84, p = 0.22). Having sepsis was associated with a decline in ADLs from baseline to 1 month post ICU discharge after adjusting for clinically relevant co-variates (parameter estimate 0.787, standard error 0.385, p= 0.04).
This study suggests that use of antibiotics and vasopressors may be associated with a decrease in mortality when treating older adults with sepsis and that sepsis may be associated with a greater decline in functional status compared to those admitted to an ICU without sepsis
P. Van Ness, None
M. Pisani, None
M. Juthani-Mehta, None