Putot Alain, Prendki Virginie
Service de Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, Sallanches, France.
Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire - EA7460, Université de Bourgogne Franche Comté, Dijon, France.
Age Ageing. 2023 Feb 1;52(2). doi: 10.1093/ageing/afad016.
Sepsis is a frequent disease in older people, characterised by an inappropriate systemic inflammatory response following an infection, leading to life-threatening organ dysfunctions. In the very old, sepsis is often difficult to diagnose, given the frequent atypical presentation. While there is no gold standard for the diagnosis of sepsis, new definitions published in 2016, aided by clinical-biological scores, namely Sequential Organ Failure Assessment (SOFA) and quick SOFA scores, allow earlier recognition of septic states at risk of poor outcome. The management of sepsis in itself differs little in older patients compared to younger subjects. However, the key question of whether or not to admit the patient to an intensive care setting has to be anticipated, depending on the sepsis severity but also on patient's comorbidities and wishes. The earliness of acute management in older subjects with decreased immune defences and physiological reserves is an essential prognostic element. The early control of comorbidities is the main plus value of the geriatrician in the acute and post-acute management of older patients with sepsis.
脓毒症是老年人的常见疾病，其特征是感染后出现不适当的全身炎症反应，导致危及生命的器官功能障碍。在高龄老人中，由于临床表现常常不典型，脓毒症往往难以诊断。虽然脓毒症的诊断没有金标准，但2016年发布的新定义，借助临床生物学评分，即序贯器官衰竭评估（SOFA）和快速SOFA评分，能够更早地识别有不良预后风险的脓毒症状态。与年轻患者相比，老年患者脓毒症的治疗本身差异不大。然而，是否将患者收入重症监护病房这一关键问题必须提前考虑，这不仅取决于脓毒症的严重程度，还取决于患者的合并症和意愿。对于免疫防御和生理储备下降的老年患者，急性治疗的及时性是一个重要的预后因素。在老年脓毒症患者的急性和急性后期管理中，早期控制合并症是老年医学专家的主要优势。
