Evaluation of Clinical Course and Outcomes of Severe Sepsis and Septic Shock in Elderly Patients.

Objective: Our objective was to prospectively evaluate patients with sepsis and septic shock in terms of their clinical course, laboratory findings, risk factors, treatment options, and prognosis. We also compared data among the elderly (≥65 years) and non-elderly (<65 years) patients with severe sepsis and septic shock. Materials and Methods: The study was a single-center prospective observational study conducted between 2014 and 2017. All adult patients with sepsis and septic shock hospitalized in the medical intensive care unit (ICU) and Infectious Diseases Department were included in the study. Results: This analysis included 250 patients admitted with severe sepsis or septic shock. Elderly patients accounted for 60.0% (150/250) of the patients. In logistic regression analyses of risk factors, elderly patients with sepsis and septic shock were more likely to have a higher odds ratios (ORs) for smoking (OR=3.658 [1.988-13.538], p=0.050), medication use (OR=5.365 [1.943-30.524], p=0.048), underlying diseases (OR=2.023 [1.333-12.292], p<0.001), hyperglycemia (OR=14.448 [2.690-77.612], p=0.002), multiple organ dysfunction syndrome (MODS) (OR=293.998 [2.247-53.713], p=0.001), and Charlson Comorbidity Index (CCI) (OR=1.301 [1.057-1.600], p=0.013). Conversely, non-elderly patients with sepsis and septic shock were more likely to have higher ORs for body mass index (BMI) (OR=0.789 [0.700-0.911], p=0.001), chronic renal failure (OR=37.076 [5.374-255.811], p<0.001), hematological malignancy (OR=84.348 [10.661-667.375], p<0.001), and leucopenia (OR=86.374 [6.622-1126.577], p=0.001). Conclusion: Elderly patients with sepsis and septic shock are more susceptible to multiple organ failure. While sepsis was not associated with increased mortality in this study, targeted early interventions may be effective in reducing mortality in older patients and in managing chronic diseases.