Are classic sepsis criteria good enough for the elderly?

Introduction: Sepsis is acquiring increasingly importance in elderly population. To date, however, very few studies have evaluated elderly patients with sepsis, often producing conflicting evidences. This study was designed to assess clinical characteristics of patients with bloodstream infections (BSIs) at hospital admission and to highlight possible differences between working age population (<65y), elderly (65-79y) and very elderly patients (≥80y).
Methods: We retrospectively evaluated 282 patients with BSIs deemed clinically significant admitted at the ASST Spedali Civili in Brescia from January 2013 to December 2015. Vital signs and laboratory markers taken at the Emergency Department (ED), SIRS criteria and MEWS score were compared between <65y, 65-79y, and ≥80y.
Results: Body temperature and white blood cell count differed significantly between <65y and ≥80y (TC 38.4°C in <65y, 37.9°C in ≥80y; WBC 9.3×103/μl in <65y, 13.0×103/μl in ≥80y). Neither SIRS nor MEWS score showed statistically significant differences between age classes. Both mortality (6.7% in <65y, 17.5% in 65-79y, and 23.1% in ≥80y) and blood cultures pathogens (gram-negative bacteria in 64.0%, 68.9%, and 80.8% respectively) differed significantly between age groups.
Discussion: Patients over 80 years, compared to working age population, presented at the ED with a significantly lower body temperature, balanced in the assessment of SIRS and MEWS by other vital signs and laboratory markers. The prevalence of gram-negative bacteria in patients above 80 reflects different risk factors and possible infection sources. Health care providers should consider these results when evaluating elderly people with suspected sepsis at hospital admission.

Davide Mangioni
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