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. 2021 Jul 9:8:697884.
doi: 10.3389/fmed.2021.697884. eCollection 2021.

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

Raphael Romano Bruno  1 , Bernhard Wernly  2   3   4 , Behrooz Mamandipoor  5 , Richard Rezar  3 , Stephan Binnebössel  1 , Philipp Heinrich Baldia  1 , Georg Wolff  1 , Malte Kelm  1 , Bertrand Guidet  6   7   8 , Dylan W De Lange  9 , Daniel Dankl  2 , Andreas Koköfer  2 , Thomas Danninger  2 , Wojciech Szczeklik  10 , Sviri Sigal  11 , Peter Vernon van Heerden  12 , Michael Beil  11 , Jesper Fjølner  13 , Susannah Leaver  14 , Hans Flaatten  15 , Venet Osmani  5 , Christian Jung  1
Affiliations

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

Raphael Romano Bruno et al. Front Med (Lausanne). .

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.

Keywords: critically ill; geriatric; intensive care; obesity; octogenarian; old; sepsis; very old.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
ICU-Mortality of the total cohort (left) and the subgroup for patients with septic shock (right), [%] **p < 0.01. ICU, Intensive care unit.
Figure 2
Figure 2
Length of stay in the total cohort (A) and the subgroup of patients with septic shock (B) stratified for length of stay categories into <72, 72–168, and >168 h. [%] **p < 0.01.
Figure 3
Figure 3
Forest plot of aOR of old vs. very old septic patients for different subgroups according to model-1 (aOR 95% CI). SOFA, Sepsis-related organ failure assessment.
Figure 4
Figure 4
Forest plot of aOR of old vs. very old septic shock patients for different subgroups according to model-1 (aOR 95% CI). SOFA, Sepsis-related organ failure assessment.
See this image and copyright information in PMC

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