Ukkonen Mika, Karlsson Sari, Laukkarinen Johanna, Rantanen Tuomo, Paajanen Hannu
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, FIN-33521, Tampere, Finland.
Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland.
J Gastrointest Surg. 2016 May;20(5):1028-33. doi: 10.1007/s11605-016-3076-4. Epub 2016 Jan 14.
We aimed to evaluate the outcome of elderly patients with severe sepsis after alimentary tract surgery.
A prospective study was conducted in 24 intensive care units (ICU) in Finland. Four thousand five hundred consecutive patients were admitted to ICUs and 470 patients fulfilled the criteria for severe sepsis. All patients who had undergone gastrointestinal surgery were included. The outcomes of elderly (≥65 years) and younger patients were compared. The key factor under analysis was death from any cause during the hospitalization or within 1 year after the surgery.
A total of 73 elderly patients (and 81 younger patients) were found to have severe alimentary tract surgery-related sepsis. The mean age of the elderly patients was 76.4 years, and 56.2 % were female. The most common indication for surgery was acute cholecystitis (21.9 %), followed by acute diverticulitis (13.7 %), and gastroduodenal ulcer (13.7 %). The anatomic site of the infection was intra-abdominal in 86.3 % of cases, the second most common being pulmonary (13.7 %). In-hospital mortality was 47.9 % and 1-year mortality 64.4 %. Of the discharged patients, 31.6 % died within 1 year. Patients who died were older and more frequently had concomitant conditions. The ICU scoring systems (APACHE, SAPS, and SOFA) and elevated lactate levels were predictive of increased mortality.
Severe sepsis among the elderly is a rare but often-fatal infectious event. In addition to high in-hospital mortality, it is also associated with significant 1-year mortality.
我们旨在评估老年患者消化道手术后严重脓毒症的预后情况。
在芬兰的24个重症监护病房（ICU）进行了一项前瞻性研究。连续有4500名患者入住ICU，其中470名患者符合严重脓毒症的标准。所有接受过胃肠道手术的患者均纳入研究。比较老年（≥65岁）和年轻患者的预后情况。分析的关键因素是住院期间或手术后1年内任何原因导致的死亡。
共发现73名老年患者（以及81名年轻患者）患有严重的消化道手术相关脓毒症。老年患者的平均年龄为76.4岁，56.2%为女性。最常见的手术指征是急性胆囊炎（21.9%），其次是急性憩室炎（13.7%）和胃十二指肠溃疡（13.7%）。86.3%的病例感染的解剖部位在腹腔内，第二常见的是肺部（13.7%）。住院死亡率为47.9%，1年死亡率为64.4%。出院患者中，31.6%在1年内死亡。死亡患者年龄较大，且更常伴有其他疾病。ICU评分系统（APACHE、SAPS和SOFA）以及乳酸水平升高可预测死亡率增加。
老年人严重脓毒症是一种罕见但往往致命的感染事件。除了高住院死亡率外，它还与显著的1年死亡率相关。
