Clinical and hemodynamic characteristics of elderly patients with severe sepsis and septic shock

Background

The number of elderly patients admitted to ICUs is high; in this setting, infectious complications are frequent. Clinical and hemodynamic characteristics of elderly patients with severe sepsis and septic shock have not been systematically reviewed in recent series.

Objectives

To analyze current clinical and hemodynamic characteristics of elderly patients with severe sepsis and septic shock admitted to the ICU.

Methods

From a prospective cohort of 340 patients admitted to a general ICU of a tertiary teaching hospital we analyzed 83 cases of septic shock and severe sepsis from June 2003 to November 2004. The APACHE II score and the Sequential Organ Failure Assessment (SOFA) score were used as prognostic indexes. Differences were considered significant when P < 0.05.

Results

Fifty-six (67.4%) patients were male and 27 (32.6%) were female; the mean age was 57.1 (16–88) years. The median for the APACHE II score was 25 (4–43). The mean ICU stay was 25 (1–171) days, and 52 (62.7%) patients died. In 40 (48.2%) cases septic shock/severe sepsis was the cause of ICU admission, and in 43 (51.8%) cases it was a complication during the ICU stay. Thirty-four (41%) patients were over 65 years old. As compared with younger patients, there was no difference regarding gender distribution, APACHE II score, SOFA score (initial, delta or maximum values), use of pulmonary artery catheter, need of mechanical ventilation, dialysis, duration of ICU stay or mortality. As for the hemodynamic parameters, however, elderly patients presented a lower cardiac index (4.6 ± 0.9 vs 3.2 ± 1.1, P = 0.01), a lower DO₂ (575.6 ± 85.5 vs 430.4 ± 121.1, P = 0.01) and a lower VO₂ (178.4 ± 65.7 vs 119.9 ± 39.6, P = 0.03). There was a trend toward a lower heart rate among elderly patients (111.7 ± 19.4 vs 90.9 ± 25.5, P = 0.06).

Conclusion

In the present study, clinical variables were similar in both young and elderly patients with severe sepsis/septic shock. However, patients over 65 years old had different hemodynamic characteristics. This finding should be considered for the diagnosis and management of elderly patients with severe sepsis and septic shock.