Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long-Term Survival

Abstract

Objectives: Sepsis has been called a "disease of the elderly," and as in-hospital mortality has decreased, more sepsis survivors are progressing into poorly characterized long-term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared with middle-aged and young adults.

Design: Prospective longitudinal study with young (≤45 years), middle-aged (46-64 years), and older (≥65 years) patient groups.

Setting: University tertiary medical center.

Participants: A total of 328 adult surgical intensive care unit (ICU) sepsis patients.

Measurements: Patients were characterized by (1) baseline demographics and predisposition, (2) septic event, (3) hospital outcomes and discharge disposition, (4) 12-month mortality, and (5) Zubrod Performance Status, physical function (Short Physical Performance Battery and handgrip strength), and cognitive function (Hopkins Verbal Learning Test, Controlled Oral Word Association, and Mini-Mental Status Examination) at 3-, 6-, and 12-month follow-up. Loss to follow-up was due to death (in 68), consent withdrawal (in 32), and illness and scheduling difficulties: month 3 (in 51), month 6 (in 29), and month 12 (in 20).

Results: Compared with young and middle-aged patients, older patients had (1) significantly more comorbidities at presentation (eg, chronic renal disease 6% vs 12% vs 21%), intra-abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%), and organ dysfunctions; (2) higher 30-day mortality (6% vs 4% vs 17%) and fewer ICU-free days (median = 25 vs 23 vs 20); (3) more progression into chronic critical illness (22% vs 34% vs 42%) with higher poor disposition discharge to non-home destinations (19% vs 40% vs 62%); (4) worse 12-month mortality (11% vs 14% vs 33%); and (5) poorer Zubrod Performance Status and objectively measured physical and cognitive functions with only slight improvement over 12-month follow-up.

Conclusion: Compared with younger patients, older sepsis survivors suffer both a higher persistent disability burden and 12-month mortality.

Keywords: cognitive function and physical function; health outcomes; older adults; sepsis.

Figure 1.

Sequental Organ Failure Assessment (SOFA) scores over 14 days by age groups. Data are presented as mean standard ± error with statistical significance set at P < .05. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2.

(A) The 12-month survival estimates and (B) Zubrod Performance Status at baseline and at 3-, 6-, and 12-month follow-up by age groups. Data for Zubrod Performance Status are presented as mean standard ± error with statistical significance set at P < .05.