The Effect of Age on the Development and Outcome of Adult Sepsis
The Effect of Age on the Development and Outcome of Adult Sepsis
Objective: Sepsis is an increasingly common and lethal medical condition that occurs in people of all ages. The influence of age on sepsis risk and outcome is incompletely understood. We sought to determine the independent effect of age on the incidence, severity, and outcome of adult sepsis.
Design: Longitudinal observational study using national hospital discharge data.
Setting: Approximately 500 geographically separated nonfederal acute care hospitals in the United States.
Patients: Patients were 10,422,301 adult sepsis patients hospitalized over 24 yrs, from 1979 to 2002.
Interventions: None.
Measurements and Main Results: Incident sepsis cases were age adjusted and characterized by demographics, sources and types of infection, comorbid medical conditions, and hospital discharge status. Elderly patients (≥65 yrs of age) accounted for 12% of the U.S. population and 64.9% of sepsis cases, yielding a relative risk of 13.1 compared with younger patients (95% confidence interval, 12.6-13.6). Elderly patients were more likely to have Gram-negative infections, particularly in association with pneumonia (relative risk, 1.66; 95% confidence interval, 1.63-1.69) and to have comorbid medical conditions (relative risk, 1.99; 95% confidence interval, 1.92-2.06). Case-fatality rates increased linearly by age; age was an independent predictor of mortality in an adjusted multivariable regression (odds ratio, 2.26; 95% confidence interval, 2.17-2.36). Elderly sepsis patients died earlier during hospitalization, and elderly survivors were more likely to be discharged to a nonacute health care facility.
Conclusions: The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.
The U.S. population continues to grow, increasing 13.2% from 1990 to 2000. Twelve percent or 35 million individuals in the United States are over age 65, and the proportion of people over age 90 increased by 42% in the past decade. Health care resource consumption for patients over age 65 is increasing, recently estimated at $387 billion per year, and will continue to increase due to greater life expectancy and approach of the baby boomers to this elderly distinction. General utilization of expensive intensive care unit (ICU) resources continues to increase and accounts for as much as 30% of all hospital costs. Intensive care utilization increases with age, and half of all ICU days are currently used by patients older than 65 yrs of age. Elderly patients will use more ICU resources in the future, as the overall population is projected to increase 50% by the year 2050 while the population over age 65 increases by >115%.
Sepsis, a life-threatening inflammatory disorder representing the immune response to an infection, is a common disorder affecting nearly 700,000 people annually in the United States. The more seriously ill sepsis patients, defined by the presence of acute organ system dysfunction, are termed severe sepsis, which may occur in one quarter of all ICU admissions and account for up to half of ICU bed-days. Unfortunately, sepsis remains a lethal disease with case-fatality rates of 20-40% and contributes to nearly 20% of all in-hospital deaths. It is the leading cause of death in noncoronary ICUs and the tenth leading cause of death overall in the United States. As the majority of severe sepsis patients require ICU care, sepsis patients contribute substantially to health care costs, estimated at $17 billion annually in the United States. Of concern, the frequency of sepsis is increasing by >5% per year, in excess of the growth and aging of our population.
Sepsis appears to be a disease of the elderly. A composite profile of severe sepsis patients from 1995 hospital discharge records in seven U.S. states reported a mean age of 63.8 yrs with an incidence of severe sepsis that increased with age. Similarly, in Europe, the median age of ICU patients who met criteria for severe sepsis was 65 yrs of age. In addition, the average age of sepsis patients in the United States is increasing over time, exceeding 65 yrs in the year 2000. Case-fatality rates have been associated with age in one study, increasing from 10% in children to 40% in patients >85 yrs of age.
Further characterization of the epidemiology of sepsis in older patients has been targeted as a critical focus for both patient care and research. An international collaboration has been established to improve care and reduce mortality with sepsis, requiring better understanding of afflicted patients. Equally important, health care providers need to understand the effect of age on the risk and outcome with sepsis to guide treatment decisions and prognostic discussions. In this article, we used a validated method to define the influence of age on the risk of sepsis and relevant clinical outcomes, with particular attention to the elderly population as defined by age ≥65 yrs. We used nationally collected hospitalization data from 1979 through 2002 to examine temporal changes in the incidence and outcome of sepsis, differences in the distribution of responsible organisms, and chronic medical conditions across age groups.
Objective: Sepsis is an increasingly common and lethal medical condition that occurs in people of all ages. The influence of age on sepsis risk and outcome is incompletely understood. We sought to determine the independent effect of age on the incidence, severity, and outcome of adult sepsis.
Design: Longitudinal observational study using national hospital discharge data.
Setting: Approximately 500 geographically separated nonfederal acute care hospitals in the United States.
Patients: Patients were 10,422,301 adult sepsis patients hospitalized over 24 yrs, from 1979 to 2002.
Interventions: None.
Measurements and Main Results: Incident sepsis cases were age adjusted and characterized by demographics, sources and types of infection, comorbid medical conditions, and hospital discharge status. Elderly patients (≥65 yrs of age) accounted for 12% of the U.S. population and 64.9% of sepsis cases, yielding a relative risk of 13.1 compared with younger patients (95% confidence interval, 12.6-13.6). Elderly patients were more likely to have Gram-negative infections, particularly in association with pneumonia (relative risk, 1.66; 95% confidence interval, 1.63-1.69) and to have comorbid medical conditions (relative risk, 1.99; 95% confidence interval, 1.92-2.06). Case-fatality rates increased linearly by age; age was an independent predictor of mortality in an adjusted multivariable regression (odds ratio, 2.26; 95% confidence interval, 2.17-2.36). Elderly sepsis patients died earlier during hospitalization, and elderly survivors were more likely to be discharged to a nonacute health care facility.
Conclusions: The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.
The U.S. population continues to grow, increasing 13.2% from 1990 to 2000. Twelve percent or 35 million individuals in the United States are over age 65, and the proportion of people over age 90 increased by 42% in the past decade. Health care resource consumption for patients over age 65 is increasing, recently estimated at $387 billion per year, and will continue to increase due to greater life expectancy and approach of the baby boomers to this elderly distinction. General utilization of expensive intensive care unit (ICU) resources continues to increase and accounts for as much as 30% of all hospital costs. Intensive care utilization increases with age, and half of all ICU days are currently used by patients older than 65 yrs of age. Elderly patients will use more ICU resources in the future, as the overall population is projected to increase 50% by the year 2050 while the population over age 65 increases by >115%.
Sepsis, a life-threatening inflammatory disorder representing the immune response to an infection, is a common disorder affecting nearly 700,000 people annually in the United States. The more seriously ill sepsis patients, defined by the presence of acute organ system dysfunction, are termed severe sepsis, which may occur in one quarter of all ICU admissions and account for up to half of ICU bed-days. Unfortunately, sepsis remains a lethal disease with case-fatality rates of 20-40% and contributes to nearly 20% of all in-hospital deaths. It is the leading cause of death in noncoronary ICUs and the tenth leading cause of death overall in the United States. As the majority of severe sepsis patients require ICU care, sepsis patients contribute substantially to health care costs, estimated at $17 billion annually in the United States. Of concern, the frequency of sepsis is increasing by >5% per year, in excess of the growth and aging of our population.
Sepsis appears to be a disease of the elderly. A composite profile of severe sepsis patients from 1995 hospital discharge records in seven U.S. states reported a mean age of 63.8 yrs with an incidence of severe sepsis that increased with age. Similarly, in Europe, the median age of ICU patients who met criteria for severe sepsis was 65 yrs of age. In addition, the average age of sepsis patients in the United States is increasing over time, exceeding 65 yrs in the year 2000. Case-fatality rates have been associated with age in one study, increasing from 10% in children to 40% in patients >85 yrs of age.
Further characterization of the epidemiology of sepsis in older patients has been targeted as a critical focus for both patient care and research. An international collaboration has been established to improve care and reduce mortality with sepsis, requiring better understanding of afflicted patients. Equally important, health care providers need to understand the effect of age on the risk and outcome with sepsis to guide treatment decisions and prognostic discussions. In this article, we used a validated method to define the influence of age on the risk of sepsis and relevant clinical outcomes, with particular attention to the elderly population as defined by age ≥65 yrs. We used nationally collected hospitalization data from 1979 through 2002 to examine temporal changes in the incidence and outcome of sepsis, differences in the distribution of responsible organisms, and chronic medical conditions across age groups.
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