Harvard Clinical Research Institute, 930 Commonwealth Ave., Boston, MA 02110, USA.
QJM. 2013 Mar;106(3):261-6. doi: 10.1093/qjmed/hcs221. Epub 2012 Nov 27.
Elderly patients are at a higher risk of acquiring sepsis, and are largely being treated in Internal Medicine (IM) departments.
To characterize the differences between nonagenarians and other age groups in patients admitted to IM departments with sepsis, and to assess predictors for survival in patients older than 90 years of age.
A prospective registry of all-comers with sepsis admitted to IM departments in a community-based Medical Center was build. Patients' demographics, medical history, clinical presentation and outcomes were recorded and analyzed according to age groups.
One thousand and eighty patients were followed for a mean of 83.63 ± 65.90 days. Nonagenarians constituted 10.93% (118/1080) of our cohort. Of these, 70.48% had a cognitive impairment and 82.60% had reduced functional state. Of these, 5.61 and 10.50% fulfilled the criteria of septic shock and severe sepsis, respectively. Sepsis category was significantly influenced by age groups (P < 0.001). Complications secondary to sepsis at admission and throughout hospitalization, and mortality rates, were higher in the nonagenarian population (61.86 vs. 51.14%, P = 0.032 and 37.29 vs. 20.06%, P < 0.001, respectively), and overall survival was significantly lower in the nonagenarian population (40.68 vs. 66.84%, P < 0.001).
Patients treated in IM departments for sepsis are old, and a significant percentage is older than 90 years of age with reduced function and mental status at baseline. These frail patients are afflicted by a worse outcome, which is most likely associated with poor functional status at baseline and severe deconditioning during the acute illness. Prognostic tools are needed to address today's trends in patient-mix and disease severity, specifically for very-old patients admitted with sepsis cared for in IM departments.
老年患者感染脓毒症的风险更高，且主要在综合内科（IM）病房接受治疗。
描述 IM 病房中脓毒症患者中 90 岁以上患者与其他年龄组患者之间的差异，并评估 90 岁以上患者的生存预测因素。
建立了一个以社区为基础的医疗中心的所有综合内科脓毒症患者的前瞻性登记处。根据年龄组记录和分析患者的人口统计学、病史、临床表现和结局。
1080 例患者的平均随访时间为 83.63 ± 65.90 天。我们的队列中有 10.93%（118/1080）为 90 岁以上患者。其中，70.48%有认知障碍，82.60%有功能状态下降。其中，5.61%和 10.50%分别符合脓毒性休克和严重脓毒症的标准。脓毒症的分类明显受年龄组的影响（P < 0.001）。入院时和整个住院期间与脓毒症相关的并发症以及死亡率在 90 岁以上患者中更高（61.86%比 51.14%，P = 0.032 和 37.29%比 20.06%，P < 0.001），90 岁以上患者的总生存率明显较低（40.68%比 66.84%，P < 0.001）。
在 IM 病房接受脓毒症治疗的患者年龄较大，其中有相当一部分年龄超过 90 岁，基线时功能和精神状态下降。这些虚弱的患者预后较差，这很可能与基线时的功能状态不佳以及急性疾病期间的严重去适应有关。需要预后工具来应对当前患者构成和疾病严重程度的趋势，特别是针对 IM 病房收治的伴有脓毒症的非常高龄患者。
