Acute Geriatric Unit, San Gerardo Hospital, Monza, MB, Italy.
Department of Statistic and Quantitative Methods, University of Milano-Bicocca, Milan, MI, Italy.
Aging Clin Exp Res. 2022 Oct;34(10):2335-2343. doi: 10.1007/s40520-022-02182-0. Epub 2022 Jul 7.
A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging.
To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis.
All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed.
We included 240 patients (median age = 85, IQR = 80-89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610-0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532-0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637-0.768) and the FI (AUROC = 0.677, 95% CI 0.607-0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term.
Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
对入住内科病房的老年脓毒症患者进行死亡率风险的预后分层往往具有挑战性。
评估序贯器官衰竭评估 (SOFA) 评分、血清生物标志物（乳酸和 C 反应蛋白，CRP）以及合并症和虚弱程度测量值在预测入住急性老年病房 (AGU) 的老年脓毒症患者的院内和 6 个月死亡率方面的能力。
本研究纳入了在研究期间因脓毒症而连续入住我们 AGU 的所有 70 岁及以上患者。入院时，进行了全面的老年评估，包括两种虚弱程度测量方法（临床虚弱量表 [CFS]、虚弱指数 [FI]）。为了评估候选预后标志物的预测能力，分析了受试者工作特征曲线下的面积（AUROC）。还进行了多变量逻辑回归分析。
我们纳入了 240 名患者（中位年龄 85 岁，IQR 80-89 岁，40.8%为女性），其中 33.8%在出院前死亡，60.4%在 6 个月时死亡。SOFA 评分（AUROC=0.678，95%CI 0.610-0.747）和 CRP 血清水平（AUROC=0.606，95%CI 0.532-0.680）是院内死亡率的良好预测指标。CFS（AUROC=0.703，95%CI 0.637-0.768）和 FI（AUROC=0.677，95%CI 0.607-0.746）更好地预测了 6 个月死亡率。回归分析的结果证实了 AUROC 研究的发现。SOFA 和虚弱程度测量值的联合评估提高了短期和长期模型的性能。
入住 AGU 时应评估器官功能障碍的严重程度和虚弱评分，以确定老年脓毒症患者的短期和长期结局。
