Factores predictivos de mortalidad de los pacientes muy añosos que se visitan en urgencias e ingresan por infección

Abstract

Objective

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

Methods

Retrospective observational study. Patients ≥ 80 years 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 87 years, 53% women). Mortality at the end of the episode was 13% (n = 127). Median survival of the series was 52 days (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.