Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1...

Area of Science:

• Geriatric Medicine
• Critical Care Medicine
• Infectious Diseases

Background:

• The population of very old intensive care patients (VIPs, aged ≥80 years) is increasing.
• VIPs experience high mortality and morbidity, raising questions about the benefits of ICU admission.
• Sepsis incidence is rising, making the identification of outcomes crucial for public health.

Purpose of the Study:

• To compare 30-day survival outcomes for VIPs admitted to the ICU for sepsis versus those admitted for other acute reasons.
• To identify prognostic factors influencing 30-day survival in VIPs.

Main Methods:

• A prospective study involving 3869 VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥2 across 307 ICUs in 21 European countries.
• Patients were categorized into sepsis and non-sepsis groups based on clinical criteria.
• Statistical analyses included unadjusted, adjusted (for age, gender, frailty, SOFA score), inverse-probability weight (IPW), and matched-pair analyses to assess 30-day survival.

Main Results:

• VIPs admitted for sepsis were younger, had higher SOFA scores, and required more intensive treatments (vasopressors, renal replacement therapy, life-sustaining limitations) compared to non-sepsis VIPs.
• Unadjusted 30-day survival was not significantly different between the groups.
• After adjustment for confounders, sepsis was not independently associated with 30-day survival (HR 0.99; P=0.917). IPW and matched-pair analyses confirmed similar survival rates.

Conclusions:

• Sepsis at ICU admission is not independently linked to reduced 30-day survival in very old patients when accounting for organ dysfunction.
• Age, frailty, and SOFA score are significant independent predictors of survival in VIPs.
• The findings suggest that critically ill elderly patients with sepsis can have similar prognoses to those with other acute conditions, emphasizing the importance of comprehensive assessment beyond the primary diagnosis.