title: Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit.
abstract: Background.  Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods.  We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results.  Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P < .001) and 117 (60%) vs 48 (42%) died within 1 year (P < .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28-2.52; P < .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87-1.84; P = .22). Conclusions.  The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced.
authors.affiliation: Section of General Internal Medicine and Geriatrics , Northwestern University , Chicago, Illinois.
authors.forename: Theresa
authors.initials: T
authors.lastname: Rowe
authors.affiliation: Department of Internal Medicine, Sections of Geriatrics.
authors.forename: Katy L B
authors.initials: KL
authors.lastname: Araujo
authors.affiliation: Department of Internal Medicine, Sections of Geriatrics.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.affiliation: Pulmonary and Critical Care.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Pisani
authors.affiliation: Infectious Diseases , Yale University School of Medicine , New Haven, Connecticut.
authors.forename: Manisha
authors.initials: M
authors.lastname: Juthani-Mehta
keywords: ICU; functional status; older adults; outcomes; sepsis