Severe sepsis and its impact on outcome in old and very old patients admitted to the intensive care unit

Introduction

Older patients comprise an increasing proportion of ICU admissions. Advanced age and multiple co-morbidities compromise their immunity and hence they may be more prone to succumbing to severe infection and have poorer outcome.

Objective

To assess the impact of severe sepsis on mortality in the old and very old subgroups of patients admitted to a medical ICU.

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. Qualitative data were analyzed using the chi-squared test or Fisher exact test as appropriate and quantitative data were analyzed using Student's t test. Inter-group and intra-group comparison for quantitative data was done by one-way ANOVA. The primary outcome measure was ICU mortality.

Results

Of 387 patients who were admitted with signs of SIRS or sepsis during the study period of 20 months, 132 patients who fulfilled the criteria for severe sepsis/septic shock were included in the analysis. The most common suspected site of infection was the lungs (60 patients, 45.5%), followed by the urinary tract (28 patients, 21.2%) and the abdomen (22 patients, 16.7%). ICU mortality in younger patients was 45.6% as compared with 60.7% in old patients and 78.9% in very old patients (P = 0.035). The odds ratio (OR) and relative risk (RR) for dying in the old age group was 1.32 (95% CI = 0.655 to 2.659) and 1.125, respectively, and OR and RR for dying was 3.313 (95% CI = 1.035 to 10.6) and 1.487 in the very old age group. There was an increased need for organ support in the old and very old population as compared with the younger population. See Table 1.

Table 1

Conclusions

The risk of dying from severe sepsis is considerably higher in the old and very old subgroup of patients. Hence, early aggressive care to recognize and manage severe sepsis is required to improve outcome.