Predictive factors of mortality in very old patients visited in Emergency Department and admitted for infection.

Abstract

Objective: To describe mortality predictive factors in patients 80years or older with infection who were visited at the emergency department and were admitted to hospital.

Methods: Retrospective observational study. Patients ≥80years old who visited the emergency department (January 1st to December 31st, 2022), whose main diagnosis was infection and required admission, were included. Factors associated with mortality at the end of the episode were determined.

Results: 987 patients were included (mean age 87years, 53% women). Mortality at the end of the episode was 13% (n=127). Median survival of the series was 52days (95%CI: 44-60). The independent factors related to mortality were: age (HR: 1.07; 95%CI: 1.03-1.11; P<.001), frailty (Clinical Frailty Scale [CFS]) (HR: 1.51; 95%CI: 1.15-1.97; P=.003), qSOFA (HR: 1.35; 95%CI: 1.07-1.70; P=.01), SOFA (HR: 1.23; 95%CI: 1.15-1.38; P<.001), leukocyte count (HR: 1.04; 95%CI: 1.02-1.06; P<.001) and criteria for sepsis and/or septic shock (HR: 2.52; 95%CI: 1.63-3.87; P<.001). On the contrary, any type of microbiological isolation was associated with lower mortality (HR: 0.44; 95%CI: 0.29-0.64; P<.001).

Conclusions: qSOFA and SOFA scores, the sepsis and septic shock criteria, as well as frailty are predictive factors of poor prognosis in very elderly patients who come to the emergency room due to infection. Knowing frailty would allow us to adapt the treatment and therapeutic effort to the patient's characteristics.