Prevalence and risk factors of sepsis in very old patients with CAP

Abstract

There is limited information about sepsis in very old patients with community-acquired pneumonia (CAP).

Retrospective study on data prospectively collected at the H. Clinic of Barcelona, including very old patients (≥80years) hospitalized with CAP between 2005-2017. We aimed to investigate the prevalence, etiology, risk factors and clinical outcomes of this population, comparing patients with and without sepsis (SEPSIS-3 criteria).

Among 4190 patients hospitalized with CAP, 1136 (27%) were very old. The incidence of sepsis was 70% (n=795). There was no significant difference in the distribution of pathogens in patients with and without sepsis. Male sex (OR 1.86) and chronic renal disease (OR 2.01) were independent RF for sepsis in the multivariable analysis, while prior antibiotic therapy before admission (OR 0.71 ) was independently associated to a lower risk of sepsis (Figure 1). 1-year mortality was higher in patients with sepsis. A propensity-adjusted multivariable analysis showed that RF for 30-day mortality in septic patients were chronic renal disease (OR 2.62) and neurological disease (OR 2.56), while diabetes mellitus (OR 0.43) was a protective factor (Fig1).

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In very old patients hospitalized with CAP, prior antibiotic therapy was associated with a decreased risk of sepsis, whereas diabetes mellitus was associated with a decreased risk of 30-day mortality.