Enrica Patrizio1, Antonella Zambon2,3, Paolo Mazzola4,5, Francesca Massariello4, Marianna Galeazzi6, Luca Cavalieri d'Oro7, Paolo Bonfanti5,8, Giuseppe Bellelli4,5. 1. Acute Geriatric Unit, San Gerardo Hospital, Monza, MB, Italy. patrizio.enrica@gmail.com. 2. Department of Statistic and Quantitative Methods, University of Milano-Bicocca, Milan, MI, Italy. 3. Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, MI, Italy. 4. Acute Geriatric Unit, San Gerardo Hospital, Monza, MB, Italy. 5. School of Medicine and Surgery, University of Milano-Bicocca, Milan, MI, Italy. 6. Medical Unit, Rho Hospital, ASST Rhodense, Rho, MI, Italy. 7. Epidemiology Unit, Local Health Unit of Brianza, Monza, MB, Italy. 8. Infectious Disease Unit, San Gerardo Hospital, Monza, MB, Italy.
Abstract
BACKGROUND: A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging. AIMS: To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis. METHODS: All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed. RESULTS: We included 240 patients (median age = 85, IQR = 80-89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610-0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532-0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637-0.768) and the FI (AUROC = 0.677, 95% CI 0.607-0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term. CONCLUSIONS: Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
BACKGROUND: A prognostic stratification of mortality risk in older patients with sepsis admitted to medical wards is often challenging. AIMS: To evaluate the ability of the Sequential Organ Failure Assessment (SOFA) score, serum biomarkers (lactate and C-Reactive Protein, CRP), and measures of comorbidity and frailty in predicting in-hospital and 6-month mortality in a cohort of older patients admitted to an Acute Geriatric Unit (AGU) with a diagnosis of sepsis. METHODS: All patients aged 70 years and over consecutively admitted to our AGU with sepsis in the study period were included. At admission, a Comprehensive Geriatric Assessment including two measures of frailty (Clinical Frailty Scale [CFS], Frailty Index [FI]) was obtained. To assess the predictivity of candidate prognostic markers, the Area Under the Receiver-Operating Characteristic (AUROC) curves were analyzed. A multivariate logistic regression analysis was also performed. RESULTS: We included 240 patients (median age = 85, IQR = 80-89, 40.8% women), of whom 33.8% died before discharge, and 60.4% at 6 months. The SOFA score (AUROC = 0.678, 95% CI 0.610-0.747) and CRP serum levels (AUROC = 0.606, 95% CI 0.532-0.680) were good predictors of in-hospital mortality. The CFS (AUROC = 0.703, 95% CI 0.637-0.768) and the FI (AUROC = 0.677, 95% CI 0.607-0.746) better predicted 6-month mortality. Results of the regression analysis confirmed the findings of the AUROC study. The combined assessment of SOFA and measures of frailty improved the performance of the model both in the short and the long term. CONCLUSIONS: Both the severity of organ dysfunction and frailty scores should be addressed on AGU admission to establish the short- and long-term outcomes of older patients with sepsis.
Authors: Shannon M Fernando; Daniel I McIsaac; Jeffrey J Perry; Bram Rochwerg; Sean M Bagshaw; Kednapa Thavorn; Andrew J E Seely; Alan J Forster; Kirsten M Fiest; Chintan Dave; Alexandre Tran; Peter M Reardon; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Med Date: 2019-08 Impact factor: 7.598
Authors: Nathan E Brummel; Susan P Bell; Timothy D Girard; Pratik P Pandharipande; James C Jackson; Alessandro Morandi; Jennifer L Thompson; Rameela Chandrasekhar; Gordon R Bernard; Robert S Dittus; Thomas M Gill; E Wesley Ely Journal: Am J Respir Crit Care Med Date: 2017-07-01 Impact factor: 21.405