Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Abstract

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

“…Proportions and ICU-mortality rates of VIPs admitted with sepsis found in our study were comparable with those found in the previous VIP-1 study [2]. A systematic review, including 18 studies and 4,256 patients aged ≥80 years admitted to the ICU with sepsis, reported ICU, hospital and 1-year mortality rates of 43%, 47% and 68%, respectively [3].…”

“…The previous VIP studies demonstrated that frailty is an important prognostic factor for short-term mortality in VIPs [1]. Sepsis as admission diagnosis appeared, after adjustment for organ dysfunction, not to be independently associated with shortterm outcome [2].…”

“…Almost 99.9% (3,591/3,596) completed the 6-month follow-up. Previously, it was demonstrated that frailty, and not sepsis, was a determinant factor for 30-day mortality [1,2,10], but the relation of other pre-existing physical and cognitive function with 6-month mortality of VIPs admitted with sepsis has not been examined. Our results are important findings to include in shared decision making.…”

“…In very old patients (age ≥ 80 years) sepsis is a frequent reason for acute intensive care unit (ICU) admission [1][2][3]. Moreover, among the patients admitted with sepsis the proportion of very old patients is increasing substantially [4].…”

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

“…For our analysis, we used the Angus criteria to detect septic patients from a large electronic database of critically ill patients (18). This yielded a large cohort of patients with a relatively low absolute mortality compared to other cohorts evaluating old septic patients-for example, Ibarz et al (21) recently reported a 43% 30 day-mortality in very old septic patients. The use of the Angus criteria might therefore constitute a limitation to our analysis.…”