The effect of age on the development and outcome of adult sepsis
The effect of age on the development and outcome of adult sepsis
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DOI：
10.1097/01.ccm.0000194535.82812.ba
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发表时间：
2006-01-01
影响因子：
8.8
通讯作者：
Moss, M
中科院分区：
文献类型：
--
作者：
Martin, GS;Mannino, DM;Moss, M
目的：脓毒症是一种越来越常见和致命的医疗状况，发生在所有年龄段的人。年龄对脓毒症风险和结果的影响尚不完全清楚。我们试图确定年龄对成人脓毒症的发生率、严重程度和结局的独立影响。设计：使用国家医院出院数据的纵向观察研究。环境：美国大约有500家地理位置分散的非联邦急症护理医院。患者：1979 - 2002年间住院的10422,301例成人败血症患者。干预措施:没有。测量和主要结果：脓毒症事件病例经年龄调整，并以人口统计学、感染来源和类型、合并症医疗条件和出院状况为特征。老年患者（>= 65岁）占美国人口的12%，占脓毒症病例的64.9%，与年轻患者相比，其相对风险为13.1（95%可信区间为12.6-13.6）。老年患者更有可能发生革兰氏阴性感染，特别是与肺炎相关（相对风险，1.66；95%可信区间，1.63-1.69），并有合并症（相对风险，1.99；95%可信区间，1.92-2.06）。病死率随年龄呈线性增长；在调整后的多变量回归中，年龄是死亡率的独立预测因子（优势比2.26；95%可信区间2.17-2.36）。老年败血症患者在住院期间死亡较早，老年幸存者更有可能出院到非急性医疗机构。结论：脓毒症的发病率在老年人中不成比例地增加，年龄是死亡率的独立预测因子。与年轻脓毒症患者相比，老年脓毒症非幸存者在住院期间死亡更早，老年幸存者在住院后更频繁地需要熟练的护理或康复护理。这些发现对患者护理和卫生保健资源优先排序具有重要意义，并为扩大科学调查和潜在的患者干预提供了见解。
Objective: Sepsis is an increasingly common and lethal medical condition that occurs in people of all ages. The influence of age on sepsis risk and outcome is incompletely understood. We sought to determine the independent effect of age on the incidence, severity, and outcome of adult sepsis.Design: Longitudinal observational study using national hospital discharge data.Setting: Approximately 500 geographically separated nonfederal acute care hospitals in the United States.Patients: Patients were 10,422,301 adult sepsis patients hospitalized over 24 yrs, from 1979 to 2002.Interventions: None.Measurements and Main Results: Incident sepsis cases were age adjusted and characterized by demographics, sources and types of infection, comorbid medical conditions, and hospital discharge status. Elderly patients (>= 65 yrs of age) accounted for 12% of the U.S. population and 64.9% of sepsis cases, yielding a relative risk of 13.1 compared with younger patients (95% confidence interval, 12.6-13.6). Elderly patients were more likely to have Gram-negative infections, particularly in association with pneumonia (relative risk, 1.66; 95% confidence interval, 1.63-1.69) and to have comorbid medical conditions (relative risk, 1.99; 95% confidence interval, 1.92-2.06). Case-fatality rates increased linearly by age; age was an independent predictor of mortality in an adjusted multivariable regression (odds ratio, 2.26; 95% confidence interval, 2.17-2.36). Elderly sepsis patients died earlier during hospitalization, and elderly survivors were more likely to be discharged to a nonacute health care facility.Conclusions: The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.