TY - JOUR
T1 - Epidemiology and Age-Related Mortality in Critically Ill Patients With Intra-Abdominal Infection or Sepsis
T2 - An International Cohort Study
AU - Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine
AU - Arvaniti, Kostoula
AU - Dimopoulos, George
AU - Antonelli, Massimo
AU - Blot, Koen
AU - Creagh-Brown, Ben
AU - Deschepper, Mieke
AU - de Lange, Dylan
AU - De Waele, Jan
AU - Dikmen, Yalim
AU - Eckmann, Christian
AU - Einav, Sharon
AU - Francois, Guy
AU - Fjeldsoee-Nielsen, Hans
AU - Girardis, Massimo
AU - Jovanovic, Bojan
AU - Lindner, Matthias
AU - Koulenti, Despoina
AU - Labeau, Sonia
AU - Lipman, Jeffrey
AU - Lipovestky, Fernando
AU - Makikado, Luis Daniel Umezawa
AU - Maseda, Emilio
AU - Mikstacki, Adam
AU - Montravers, Philippe
AU - Paiva, José Artur
AU - Pereyra, Cecilia
AU - Rello, Jordi
AU - Timsit, Jean-Francois
AU - Tomescu, Dana
AU - Vogelaers, Dirk
AU - Blot, Stijn
N1 - Copyright © 2022 Elsevier Ltd. All rights reserved.
PY - 2022/7
Y1 - 2022/7
N2 - OBJECTIVE: To describe epidemiology and age-related mortality in critically ill older adults with intra-abdominal infection.METHODS: A secondary analysis was undertaken of a prospective, multi-national, observational study (Abdominal Sepsis Study, ClinicalTrials.gov #NCT03270345) including patients with intra-abdominal infection from 309 intensive care units (ICUs) in 42 countries between January and December 2016. Mortality was considered as ICU mortality, with a minimum of 28 days of observation when patients were discharged earlier. Relationships with mortality were assessed by logistic regression analysis.RESULTS: The cohort included 2337 patients. Four age groups were defined: middle-aged patients [reference category; 40-59 years; n=659 (28.2%)], young-old patients [60-69 years; n=622 (26.6%)], middle-old patients [70-79 years; n=667 (28.5%)] and very old patients [≥80 years; n=389 (16.6%)]. Secondary peritonitis was the predominant infection (68.7%) and was equally prevalent across age groups. Mortality increased with age: 20.9% in middle-aged patients, 30.5% in young-old patients, 31.2% in middle-old patients, and 44.7% in very old patients (P<0.001). Compared with middle-aged patients, young-old age [odds ratio (OR) 1.62, 95% confidence interval (CI) 1.21-2.17], middle-old age (OR 1.80, 95% CI 1.35-2.41) and very old age (OR 3.69, 95% CI 2.66-5.12) were independently associated with mortality. Other independent risk factors for mortality included late-onset hospital-acquired intra-abdominal infection, diffuse peritonitis, sepsis/septic shock, source control failure, liver disease, congestive heart failure, diabetes and malnutrition.CONCLUSIONS: For ICU patients with intra-abdominal infection, age >60 years was associated with mortality; patients aged ≥80 years had the worst prognosis. Comorbidities and overall disease severity further compromised survival. As all of these factors are non-modifiable, it remains unclear how to improve outcomes.
AB - OBJECTIVE: To describe epidemiology and age-related mortality in critically ill older adults with intra-abdominal infection.METHODS: A secondary analysis was undertaken of a prospective, multi-national, observational study (Abdominal Sepsis Study, ClinicalTrials.gov #NCT03270345) including patients with intra-abdominal infection from 309 intensive care units (ICUs) in 42 countries between January and December 2016. Mortality was considered as ICU mortality, with a minimum of 28 days of observation when patients were discharged earlier. Relationships with mortality were assessed by logistic regression analysis.RESULTS: The cohort included 2337 patients. Four age groups were defined: middle-aged patients [reference category; 40-59 years; n=659 (28.2%)], young-old patients [60-69 years; n=622 (26.6%)], middle-old patients [70-79 years; n=667 (28.5%)] and very old patients [≥80 years; n=389 (16.6%)]. Secondary peritonitis was the predominant infection (68.7%) and was equally prevalent across age groups. Mortality increased with age: 20.9% in middle-aged patients, 30.5% in young-old patients, 31.2% in middle-old patients, and 44.7% in very old patients (P<0.001). Compared with middle-aged patients, young-old age [odds ratio (OR) 1.62, 95% confidence interval (CI) 1.21-2.17], middle-old age (OR 1.80, 95% CI 1.35-2.41) and very old age (OR 3.69, 95% CI 2.66-5.12) were independently associated with mortality. Other independent risk factors for mortality included late-onset hospital-acquired intra-abdominal infection, diffuse peritonitis, sepsis/septic shock, source control failure, liver disease, congestive heart failure, diabetes and malnutrition.CONCLUSIONS: For ICU patients with intra-abdominal infection, age >60 years was associated with mortality; patients aged ≥80 years had the worst prognosis. Comorbidities and overall disease severity further compromised survival. As all of these factors are non-modifiable, it remains unclear how to improve outcomes.
KW - Adult
KW - Aged
KW - Cohort Studies
KW - Critical Illness
KW - Cross Infection
KW - Hospital Mortality
KW - Humans
KW - Intensive Care Units
KW - Intraabdominal Infections/epidemiology
KW - Middle Aged
KW - Peritonitis
KW - Prospective Studies
KW - Sepsis
KW - Shock, Septic
KW - Young Adult
U2 - 10.1016/j.ijantimicag.2022.106591
DO - 10.1016/j.ijantimicag.2022.106591
M3 - Article
C2 - 35460850
SN - 0924-8579
VL - 60
SP - 106591
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 1
ER -