Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit.

BACKGROUND: Elderly patients comprise an increasing proportion of intensive care unit (ICU) admissions. Advanced age and multiple comorbidities compromise their immunity and hence they may be more prone to succumbing to severe infection and have poorer outcome. We undertook this study to review impact of severe sepsis on mortality in the elderly patients.

METHODS: All patients admitted to a medical ICU of a tertiary care institute with severe sepsis or septic shock were prospectively included. Patients were divided into young (age below 60 years), old (age between 60 and 80 years), and very old (age above 80 years) groups. Data regarding baseline patient characteristics, admission APACHE II score, and ICU course including need for organ support and ICU length of stay were noted. Categorical data were analyzed using χ(2) or Fisher Exact test as appropriate and continuous data were analyzed using Student t test. Primary outcome measure was the ICU mortality.

RESULTS: Of 387 patients with sepsis, 132 patients who fulfilled the criteria for severe sepsis/septic shock were included in the analysis. The most common suspected site of infection was lungs (45.5%), followed by urinary tract (21.2%) and abdomen (16.7%). Intensive care unit mortality in younger patients was 45.6% as compared to 60.7% in old and 78.9% in very old patients (P = .035). The relative risk (RR) for dying in the old age was 1.125 and RR for dying in the very old age group was 1.487 as compared to the young patients. There was an increased need for organ support in the elderly and very elderly population as compared to the younger population. On multivariate analysis, only age of the patient was found to be independently predicting ICU mortality (P = .002, OR: 1.038, 95% CI: 1.014-1.062).

CONCLUSIONS: The risk of dying from severe sepsis is considerably higher in the elderly and very elderly subgroup of patients with age as an independent risk factor for mortality. Hence, early aggressive care to recognize and manage severe sepsis is required to improve outcome.