Altern Ther Health Med. 2024 Feb;30(2):124-130.
The primary objectives of this study were to compare the characteristics of older and younger patients with sepsis and to analyze risk factors associated with 28-day and 90-day mortality in critically ill patients. Our study aimed to explore whether there are significant differences between sepsis patients in different age groups and whether these differences are related to the association between disease severity and mortality.
We conducted a single-center, retrospective study of 5783 critically ill patients over 18 years of age from the Medical Information Mart for Intensive Care III database diagnosed with sepsis and admitted to the intensive care unit between 2008 and 2012. We performed a retrospective analysis, selected the Critical Care Medicine Information Mart III database, and collected data on patients with sepsis. We then collated and analyzed these data to compare differences in characteristics between older and younger patients and identify associated risk factors, which can help understand patient mortality. This approach leverages existing clinical data and avoids new experiments or data collection. Kaplan-Meier survival curve was used to assess 28-day and 90-day mortality, and a Cox proportional hazards regression model was used to evaluate the associated risk factors with 28-day and 90-day mortality.
Our study identified significant differences in mortality between older and younger patients with sepsis, finding that older patients had significantly higher mortality than younger patients. Furthermore, we successfully identified risk factors associated with mortality, results that have important implications for optimizing patient care and making clinical decisions. Of 5783 patients with sepsis, 2044 (35.3%) were younger than 60 years, and 3739 (64.7%) were aged 60 years or older. The 28-day mortality rate was 11.8% and 21.2% in the younger and older cohorts, respectively (P < .01). In the age-stratified analysis, the 28-day mortality was the highest in patients aged over 80 years (14.6% vs. 21.2% vs. 26.8%, P < .001). Factors associated with 28-day and 90-day mortality in patients with sepsis included age, weight, the need for mechanical ventilation, congestive heart failure, chronic pulmonary disease, malignancy, and Sequential Organ Failure Assessment score. Higher mortality in older patients with sepsis suggests the need for more aggressive treatment and monitoring. We also identified risk factors associated with mortality, helping to develop individualized treatment strategies. In addition, the different clinical characteristics of patients in different age groups emphasize the need for refined care pathways to meet their special needs. These results will help improve the treatment effect and quality of life of patients with sepsis.
Our study fills the knowledge gap on the manifestations of sepsis patients in different age groups and helps medical staff better predict and manage disease progression in these two groups and provide personalized treatment. This lays the foundation for future in-depth research on age-related sepsis factors and is expected to improve patient survival and recovery rates. Older patients with sepsis had higher mortality rates and adverse outcomes. The mortality rate in patients with sepsis gradually increased with age. The importance of these findings is that they can help guide patient care and clinical decision-making, particularly when dealing with older and younger patients with sepsis, to improve treatment outcomes and reduce mortality. We would like to acknowledge that there are several limitations to the study, including the selectivity of the database and the retrospective nature, which preclude inference of causal relationships. In addition, some unconsidered variables may affect the results, and missing information in the data may also have an impact on the study. Future research could further explore these issues.This study highlights the critical role of age in sepsis patient outcomes and provides a strong basis for more sophisticated care and treatment. Our findings will help save more lives and improve patients' chances of recovery, which has profound implications for future research and clinical practice in the field of sepsis.
本研究的主要目的是比较老年和年轻脓毒症患者的特征，并分析危重症患者 28 天和 90 天死亡率的相关风险因素。我们的研究旨在探讨不同年龄组脓毒症患者之间是否存在显著差异，以及这些差异是否与疾病严重程度和死亡率之间的关联有关。
我们对 2008 年至 2012 年期间入住重症监护病房的年龄在 18 岁以上的来自医疗信息集市 III 数据库的 5783 例确诊为脓毒症的危重症患者进行了单中心、回顾性研究。我们进行了回顾性分析，选择了危重病医学信息集市 III 数据库，并收集了脓毒症患者的数据。然后，我们对这些数据进行了整理和分析，以比较老年和年轻患者之间的特征差异，并确定相关的风险因素，这有助于了解患者的死亡率。这种方法利用了现有的临床数据，避免了新的实验或数据收集。Kaplan-Meier 生存曲线用于评估 28 天和 90 天的死亡率，Cox 比例风险回归模型用于评估与 28 天和 90 天死亡率相关的风险因素。
我们的研究发现，老年和年轻脓毒症患者的死亡率存在显著差异，老年患者的死亡率明显高于年轻患者。此外，我们成功地确定了与死亡率相关的风险因素，这些结果对优化患者护理和做出临床决策具有重要意义。在 5783 例脓毒症患者中，2044 例（35.3%）年龄小于 60 岁，3739 例（64.7%）年龄为 60 岁或以上。年轻和老年队列的 28 天死亡率分别为 11.8%和 21.2%（P <.01）。在年龄分层分析中，80 岁以上患者的 28 天死亡率最高（14.6%比 21.2%比 26.8%，P <.001）。与脓毒症患者 28 天和 90 天死亡率相关的因素包括年龄、体重、需要机械通气、充血性心力衰竭、慢性肺部疾病、恶性肿瘤和序贯器官衰竭评估评分。老年脓毒症患者的死亡率较高，提示需要更积极的治疗和监测。我们还确定了与死亡率相关的风险因素，有助于制定个体化的治疗策略。此外，不同年龄组患者的不同临床特征强调需要制定精细化的护理路径，以满足他们的特殊需求。这些结果将有助于提高脓毒症患者的治疗效果和生活质量。
我们的研究填补了不同年龄组脓毒症患者表现的知识空白，有助于医务人员更好地预测和管理这两个年龄段患者疾病的进展，并提供个性化的治疗。这为未来深入研究与年龄相关的脓毒症因素奠定了基础，有望提高患者的生存率和康复率。老年脓毒症患者的死亡率和不良预后较高。脓毒症患者的死亡率随着年龄的增长而逐渐增加。这些发现的重要性在于，它们可以帮助指导患者护理和临床决策，特别是在处理老年和年轻的脓毒症患者时，以改善治疗结果并降低死亡率。我们想承认，这项研究存在一些局限性，包括数据库的选择性和回顾性，这使得我们无法推断因果关系。此外，一些未考虑到的变量可能会影响结果，并且数据中的缺失信息也可能会对研究产生影响。未来的研究可以进一步探讨这些问题。本研究强调了年龄在脓毒症患者预后中的关键作用，并为更精细的护理和治疗提供了坚实的基础。我们的发现将有助于挽救更多的生命，提高患者的康复机会，这对脓毒症领域的未来研究和临床实践具有深远的意义。
