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Comparative analysis of survival between older and nonolder severe sepsis and septic shock resuscitated patients
Critical Care volume 17, Article number: P45 (2013)
Advanced age has been associated with increased mortality in severe sepsis and septic shock patients [1, 2]. However, the impact of early resuscitation following the Surviving Sepsis Campaign Guidelines in this population of patients is unclear. The objective of this study was to compare the in-hospital mortality between older (EP) and nonolder (N-EP) resuscitated patients according to the Surviving Sepsis Campaign Guidelines.
A retrospective observational study. All patients with severe sepsis and septic shock admitted to the ICU between January 2006 and March 2012 were studied. Comparisons were performed between older (≥65 years) and nonolder patients (<65 years).
A total of 913 patients with severe sepsis and septic shock were included in this analysis. Older patients accounted for 63% (573/913) of patients and nonolder patients for 37% (340/913) of patients. The median (IQR) age was 80 years (73 to 85) and 51 years (40 to 59) for EP and N-EP, respectively. The incidence of severe sepsis (43% vs. 44%) and septic shock (57% vs. 56%) did not differ between the EP and N-EP groups (P = 0.78). EP patients had a higher median (IQR) APACHE II score (23 (18 to 28)) than N-EP patients (19 (16 to 24), P < 0.001), although the median number of organ dysfunctions (3 vs. 2 for EP and N-EP, respectively, P = 0.57) did not differ between the groups. EP patients were more likely to have hypertension (51% vs. 29%, P <0.001), diabetes (33% vs. 24%, P = 0.02), ischemic heart disease (16% vs. 7%, P <0.001) and chronic renal failure (8.5% vs. 4.2%, P <0.03) when compared with N-EP patients. Solid organ transplantation (24% vs. 4%, P <0.001) and liver cirrhosis (17% vs. 5%, P <0.001) were more frequently in N-EP patients. There was no significant between-group difference in the in-hospital mortality (33% in the EP group and 28% in the N-EP group; odds ratio, 1.27; 95% CI, 0.94 to 1.70; P = 0.12) (Figure 1). The length of hospital stay (14 (7 to 29) vs. 12 (6 to 21) days (median (IQR)), P = 0.001) was significantly higher in EP patients compared with the N-EP patients.
In this population of severe sepsis and septic shock patients, the early resuscitation of older patients was not associated with increased mortality. However, prospective studies addressing the long-term impact of the resuscitation maneuvers on outcomes are necessary.
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Martin GS: Crit Care Med. 2006, 34: 15-21. 10.1097/01.CCM.0000194535.82812.BA
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Palomba, H., Correa, T., Assunção, M. et al. Comparative analysis of survival between older and nonolder severe sepsis and septic shock resuscitated patients. Crit Care 17, P45 (2013). https://doi.org/10.1186/cc12661
- Septic Shock
- Liver Cirrhosis
- Severe Sepsis
- Ischemic Heart Disease
- Chronic Renal Failure