Sepsis in nonagenarians admitted to internal medicine departments: a comparative study of outcomes

Elderly patients are at a higher risk of acquiring sepsis, and are largely being treated in Internal Medicine (IM) departments.

To characterize the differences between nonagenarians and other age groups in patients admitted to IM departments with sepsis, and to assess predictors for survival in patients older than 90 years of age.

A prospective registry of all-comers with sepsis admitted to IM departments in a community-based Medical Center was build. Patients' demographics, medical history, clinical presentation and outcomes were recorded and analyzed according to age groups.

One thousand and eighty patients were followed for a mean of 83.63 ± 65.90 days. Nonagenarians constituted 10.93% (118/1080) of our cohort. Of these, 70.48% had a cognitive impairment and 82.60% had reduced functional state. Of these, 5.61 and 10.50% fulfilled the criteria of septic shock and severe sepsis, respectively. Sepsis category was significantly influenced by age groups (P < 0.001). Complications secondary to sepsis at admission and throughout hospitalization, and mortality rates, were higher in the nonagenarian population (61.86 vs. 51.14%, P = 0.032 and 37.29 vs. 20.06%, P < 0.001, respectively), and overall survival was significantly lower in the nonagenarian population (40.68 vs. 66.84%, P < 0.001).

Patients treated in IM departments for sepsis are old, and a significant percentage is older than 90 years of age with reduced function and mental status at baseline. These frail patients are afflicted by a worse outcome, which is most likely associated with poor functional status at baseline and severe deconditioning during the acute illness. Prognostic tools are needed to address today's trends in patient-mix and disease severity, specifically for very-old patients admitted with sepsis cared for in IM departments.