Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort...

Area of Science:

• Critical Care Medicine
• Epidemiology
• Gerontology

Background:

• Sepsis is a major global cause of death.
• Understanding risk factors like age and comorbidities is crucial for improving outcomes in septic shock.

Purpose of the Study:

• To evaluate the independent and combined effects of age and chronic comorbidities on 28-day mortality in patients with septic shock.
• To identify factors influencing clinical outcomes in septic shock patients.

Main Methods:

• A multicenter retrospective observational study using the Korean Shock Society registry (2015-2023).
• Included adults with suspected infection and refractory hypotension/hypoperfusion.
• Analyzed 28-day mortality using multivariable logistic regression, stratifying by age and comorbidity status.

Main Results:

• The overall 28-day mortality rate was 22.9% among 8787 patients.
• Elderly patients (≥75 years) with comorbidities had the highest mortality (27.5%).
• Both advanced age (aOR 3.21 for ≥75) and presence of comorbidities (aOR 2.67) were independently associated with increased mortality.
• A significant interaction (p=0.008) between age and comorbidity status was observed, indicating effect modification.

Conclusions:

• Age and comorbidities are significant independent predictors of septic shock mortality.
• The interaction between age and comorbidities demonstrates that their combined impact on mortality is greater than the sum of their individual effects.
• Prognostic impact of comorbidities varies by age group, and age-related mortality gradients are influenced by comorbidity burden.