Predictors of outcome in older adults admitted with sepsis in a tertiary care center

Abstract

Background: Although there is increasing interest in exploring outcomes and predictors of outcomes of older adults who present with sepsis in developing countries, there is limited information from the low- and middle-income countries. Objective: This study was done to determine inhospital mortality and ascertain the factors predicting mortality among older inpatients with sepsis. Materials and Methods: This was a prospective observational study, from March 2018 to September 2019 in a tertiary care center in India. Baseline clinical, demographic, laboratory parameters and mortality were recorded from patients above the age of 60 years with a diagnosis of sepsis who were admitted to either the ward or intensive care unit (ICU). Logistic regression analysis was performed to determine predictors of inhospital mortality. Results: We found that 201 patients, predominantly male (64.6%) with a mean (standard deviation) age of 70.3 (7.8) years and a median (interquartile range) admission Sequential Organ Failure Assessment score of 5 (3–7), were admitted with sepsis. Lung infection was the most common source of sepsis (47.2%). Seventy-three patients (36.3%) required ICU admission, and inhospital mortality was 40.2%. Predictors of mortality included high Charlson Comorbidity Index (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1–1.6, P = 0.08), serum albumin (OR: 0.41, 95% CI: 0.20–0.80, P = 0.009), invasive mechanical ventilation (OR: 3.24, 95% CI: 1.2–8.9, P = 0.022), and the use of vasoactive agents (OR: 7.44, 95% CI: 2.8–19.9, P < 0.001). Blood culture positivity was found to have a survival benefit on Kaplan–Meier estimates. Conclusion: The mortality rate in older inpatients with sepsis was 40.2%. A high comorbidity burden, low serum albumin, and the need for invasive mechanical ventilation and vasoactive agents were independent predictors of mortality.