Résumé
•Older age reduces the odds of survival in intensive care unit patients with intra-abdominal infection/sepsis.•In octogenarians with diffuse peritonitis and sepsis/septic shock, mortality may increase up to 70%.•Underlying conditions such as diabetes, chronic heart failure, liver disease and malnutrition further burden the prognosis.•As these risk factors for death are non-modifiable, it is unclear how to improve survival in older adults with intra-abdominal infection/sepsis.•These data stress the importance of timely patient- and family-centred care conferences discussing realistic goals of care.
To describe epidemiology and age-related mortality in critically ill older adults with intra-abdominal infection.
A secondary analysis was undertaken of a prospective, multi-national, observational study (Abdominal Sepsis Study, ClinicalTrials.gov #NCT03270345) including patients with intra-abdominal infection from 309 intensive care units (ICUs) in 42 countries between January and December 2016. Mortality was considered as ICU mortality, with a minimum of 28 days of observation when patients were discharged earlier. Relationships with mortality were assessed by logistic regression analysis.
The cohort included 2337 patients. Four age groups were defined: middle-aged patients [reference category; 40–59 years; n=659 (28.2%)], young-old patients [60–69 years; n=622 (26.6%)], middle-old patients [70–79 years; n=667 (28.5%)] and very old patients [≥80 years; n=389 (16.6%)]. Secondary peritonitis was the predominant infection (68.7%) and was equally prevalent across age groups. Mortality increased with age: 20.9% in middle-aged patients, 30.5% in young-old patients, 31.2% in middle-old patients, and 44.7% in very old patients (P<0.001). Compared with middle-aged patients, young-old age [odds ratio (OR) 1.62, 95% confidence interval (CI) 1.21–2.17], middle-old age (OR 1.80, 95% CI 1.35–2.41) and very old age (OR 3.69, 95% CI 2.66–5.12) were independently associated with mortality. Other independent risk factors for mortality included late-onset hospital-acquired intra-abdominal infection, diffuse peritonitis, sepsis/septic shock, source control failure, liver disease, congestive heart failure, diabetes and malnutrition.
For ICU patients with intra-abdominal infection, age >60 years was associated with mortality; patients aged ≥80 years had the worst prognosis. Comorbidities and overall disease severity further compromised survival. As all of these factors are non-modifiable, it remains unclear how to improve outcomes.