Factors associated with mortality in older sepsis patients: a nationwide retrospective cohort study in Germany

Sepsis is a leading cause of mortality in older adults, but large unselected cohort data on factors associated with mortality remain limited.

To examine patient characteristics and acute illness features associated with mortality among older patients hospitalised with sepsis in Germany.

We conducted a retrospective, observational cohort study using statutory health insurance data (AOK) of patients aged ≥70 years and hospitalised with sepsis between 2016 and 2019. Outcomes were in-hospital and 90-day post-discharge mortality. Multivariate blockwise logistic regression models were applied to examine associations across conceptual domains.

Of 227 110 older sepsis patients [median age, 81 years (IQR 76-85); 49.2% women], in-hospital mortality was 35.2%. Organ dysfunction, particularly hepatic and renal dysfunction, as well as receipt of organ support including mechanical ventilation and dialysis, showed strong associations with in-hospital mortality. Among 147 080 patients discharged alive, 19.5% died within 90 days. In this post-discharge phase, care dependency and metastatic cancer showed stronger associations with mortality, whereas associations with acute illness features were lower. Female sex was independently associated with lower mortality and conferred a survival advantage after discharge.

The high mortality rate of older sepsis patients is associated with both baseline patient vulnerability and acute illness severity. Care dependency, used as a proxy for functional vulnerability overlapping with frailty, showed a strong association with mortality, particularly after discharge. These findings highlight the importance of integrating preexisting patient vulnerability and acute illness characteristics to guide individualised acute and post-discharge care for older sepsis patients.