Comparative analysis of survival between older and nonolder severe sepsis and septic shock resuscitated patients

Introduction

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.

Methods

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).

Results

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.

Figure 1

Survival analysis comparing older and nonolder patients.

Conclusion

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.