PURPOSE: Sepsis is associated with higher morbidity, mortality and health care cost in the US. Limited data are available regarding the impact of sepsis in elderly patients with immunosuppression. Therefore, our aim was to determine the impact on mortality for patients with immunosuppression that develop severe sepsis.
METHODS: A retrospective administrative data of hospitalized inpatients aged >/= 65 years with a discharge diagnosis of sepsis (by ICD-9 codes 0.38 and 0.20) in fiscal years 2002-2007, and at least 1 year of Department of Veterans affairs outpatient care before the index admission were included. Severe sepsis was defined as sepsis with at least one organ failure. Immunosuppression was constructed as a comprehensive variable that included active malignancy, immunosuppressive therapies and diagnosis (e.g. HIV/AIDS, medications, neutropenia, etc). Primary outcome was 30-day mortality. Chi-square and Student's t-test were used to compare categorical and continuous variables, respectively. Multivariable analysis was performed using 30-day mortality as the dependent variable and independent variables that were p <0.1 in the bivariate analysis.
RESULTS: Our results showed that severe sepsis was present in 9,139 subjects. The most common immunosuppressive conditions included: any type of cancer (25%), solid organ tumor (27%), and corticosteroid therapy (22%). Multivariable analysis (Odds ratio [OR], 95% Confidence Intervals [CI]; p value) showed that age (OR=1.03; 95%CI 1.03-1.04; p<.001), mechanical ventilation (OR=1.23; 95%CI 1.13-1.34; p<.001), lung metastasis (OR=1.34; 95%CI 1.13-1.60; p=.001), neutropenia (OR=1.53; 95%CI 1.15-2.03; p=.003), and cisplatin therapy (OR=2.21; 95%CI 1.07-4.58; p=.03) were associated with higher 30-day mortality. In contrast the use of corticosteroid therapy was associated with lower 30-day mortality (OR=0.62; 95%CI .56-.69; p<.001) in severe septic patients.
CONCLUSIONS: Elderly patients with severe sepsis and immunosuppression, lung metastasis, neutropenia and cisplatin therapy are associated higher 30-day mortality. In contrast corticosteroid therapy is associated with lower 30-day mortality.
CLINICAL IMPLICATIONS: Further prospective studies are needed to evaluate the impact of sepsis in patients with immunosuppression.
DISCLOSURE: The following authors have nothing to disclose: Juan Fernandez, Andrew Shorr, Eric Mortensen, Antonio Anzueto, Marcos Restrepo
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