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Outcomes of Elderly Patients Admitted to a Medical ICU With Severe Sepsis and Septic Shock FREE TO VIEW

Praveen Vijhani; Gabriel Patarroyo; Abhijit Duggal; Jorge Guzman
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Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):240A. doi:10.1378/chest.1993877
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SESSION TITLE: Sepsis & Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 04:30 PM - 05:30 PM

PURPOSE: We describe differences in outcomes associated with severe sepsis and septic shock in elderly patients (>65≤80 years) compared to very elderly (>80 years) admitted to a medical intensive care unit (MICU) in a quaternary care hospital.

METHODS: A retrospective analysis of 627 patients >65 years of age admitted to the MICU with severe sepsis/septic shock from 2008-2013 was performed. Data on the demographics, co-morbidities, initial discharge, severity of illness and outcomes including immediate and short-term mortality were collected. Outcomes of interest included mortality within 72 hours of ICU admission, short-term mortality (ICU and hospital) and functional status at the time of discharge.

RESULTS: 627 patients were included in our cohort; 141 (22.5%) were > 80 years of age. Elderly and very elderly patients had similar rates of co-morbidities, admission APACHE III scores (99.8±33.3 vs 104.9±34.1), and vasopressor use (74% vs 72%, p0.5). Very elderly were less likely to receive mechanical ventilation (52% vs 28%, p0.05) on the first day of admission to MICU. There was no difference in the rates of limitation of therapy based on advanced directives between the two groups. The duration of mechanical ventilation (p0.5) and length of stay in the ICU (p0.16) were similar in the two groups, but the very elderly had a shorter hospital length of stay (p0.05). MICU and hospital mortality was comparable (32% vs 31%, and 42% vs 40%, respectively). Functional status at hospital discharge was also comparable. Eighty seven percent of the very elderly and 81% of the elderly required assistance for daily living at hospital discharge. Length of stay in ICU did not correlate with the degree of functional dependency at hospital discharge.

CONCLUSIONS: Elderly and very elderly patients with severe sepsis and septic shock have comparable outcomes and rates of functional dependency at hospital discharge. A short ICU and hospital stay does not translate in better functional outcomes.

CLINICAL IMPLICATIONS: Age should not be considered a limiting factor when deciding aggressiveness of ICU care.

DISCLOSURE: The following authors have nothing to disclose: Praveen Vijhani, Gabriel Patarroyo, Abhijit Duggal, Jorge Guzman

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