Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand.
West J Emerg Med. 2020 Oct 6;21(6):210-218. doi: 10.5811/westjem.2020.7.47405.
Elderly patients are at increased risk of developing sepsis and its adverse outcomes. Diagnosing and prognosing sepsis is particularly challenging in older patients, especially early at emergency department (ED) arrival. We aimed to study and compare the characteristics of elderly and very elderly ED patients with sepsis and determine baseline factors associated with in-hospital mortality. We also compared prognostic accuracy of the criteria for systemic inflammatory response syndrome, quick sequential organ failure assessment (qSOFA), and the National Early Warning Score in predicting mortality.
We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University in Bangkok, Thailand. Patients over 18 years old who were diagnosed and treated for sepsis in the ED between August 2018-July 2019 were included. We categorized patients into non-elderly (aged <65 years), elderly (aged 65-79 years), and the very elderly (aged >80 years) groups. The primary outcome was in-hospital mortality. Baseline demographics, comorbidities, source and etiology of sepsis, including physiologic variables, were compared and analyzed to identify predictors of mortality. We calculated and compared the area under the receiver operator characteristics curves (AUROC) of early warning scores.
Of 1616 ED patients with sepsis, 668 (41.3%) were very elderly, 512 (31.7%) were elderly, and 436 (27.0%) were non-elderly. The mortality rate was highest in the very elderly, followed by the elderly and the non-elderly groups (32.3%, 25.8%, and 24.8%, respectively). Factors associated with mortality in the very elderly included the following: age; do-not-resuscitate (DNR) status; history of recent admission <3 months; respiratory tract infection; systolic blood pressure <100 millimeters mercury (SBP<100); oxygen saturation; and Glasgow Coma Scale (GCS) score. Factors associated with mortality in the elderly were DNR status, body temperature, and GCS score. qSOFA had the highest AUROC in predicting in-hospital mortality in both very elderly and elderly patients (AUROC 0.60 [95% confidence interval {CI}, 0.55-0.65] and 0.55 [95% CI, 0.49-0.61, respectively]).
The mortality rate in the very elderly was higher than in the younger populations. Age, DNR status, recent admission, respiratory tract infection, SBP<100, oxygen saturation. and GCS score independently predicted hospital mortality in very elderly patients. The qSOFA score had better but only moderate accuracy in predicting mortality in elderly and very elderly sepsis patients.
老年患者发生脓毒症及其不良结局的风险增加。诊断和预测老年患者脓毒症尤其具有挑战性，尤其是在急诊科（ED）就诊的早期。我们旨在研究和比较患有脓毒症的老年和非常老年 ED 患者的特征，并确定与院内死亡率相关的基线因素。我们还比较了全身炎症反应综合征、快速序贯器官衰竭评估（qSOFA）和国家早期预警评分预测死亡率的准确性。
我们在泰国曼谷玛希隆大学 Siriraj 医院的 ED 进行了一项回顾性研究。纳入 2018 年 8 月至 2019 年 7 月期间在 ED 被诊断和治疗为脓毒症的年龄大于 18 岁的患者。我们将患者分为非老年组（年龄<65 岁）、老年组（年龄 65-79 岁）和非常老年组（年龄>80 岁）。主要结局是院内死亡率。比较和分析基线人口统计学、合并症、脓毒症的来源和病因，包括生理变量，以确定死亡率的预测因素。我们计算并比较了早期预警评分的受试者工作特征曲线（ROC）下面积（AUROC）。
在 1616 例 ED 脓毒症患者中，668 例（41.3%）为非常老年，512 例（31.7%）为老年，436 例（27.0%）为非老年。死亡率最高的是非常老年组，其次是老年组和非老年组（分别为 32.3%、25.8%和 24.8%）。与非常老年组患者死亡相关的因素包括：年龄；不复苏（DNR）状态；最近入院<3 个月；呼吸道感染；收缩压<100 毫米汞柱（SBP<100）；氧饱和度；和格拉斯哥昏迷量表（GCS）评分。与老年组患者死亡相关的因素包括：DNR 状态、体温和 GCS 评分。qSOFA 在预测非常老年和老年患者院内死亡率方面具有最高的 AUROC（AUROC 分别为 0.60 [95%置信区间 {CI}，0.55-0.65]和 0.55 [95% CI，0.49-0.61]）。
非常老年患者的死亡率高于年轻人群。年龄、DNR 状态、近期入院、呼吸道感染、SBP<100、氧饱和度和 GCS 评分独立预测非常老年患者的住院死亡率。qSOFA 评分在预测老年和非常老年脓毒症患者的死亡率方面具有较好但仅为中等准确性。
