Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study

被引：26

作者：

Arvaniti, Kostoula ^{[1
]}

Dimopoulos, George ^{[2
]}

Antonelli, Massimo ^{[3
,4
]}

Blot, Koen ^{[5
]}

Creagh-Brown, Ben ^{[6
,7
]}

Deschepper, Mieke ^{[8
]}

de Lange, Dylan ^{[9
]}

De Waele, Jan ^{[10
]}

Dikmen, Yalim ^{[11
]}

Eckmann, Christian ^{[12
]}

Einav, Sharon ^{[13
,14
]}

Francois, Guy ^{[15
]}

Fjeldsoee-Nielsen, Hans ^{[16
]}

Girardis, Massimo ^{[17
]}

Jovanovic, Bojan ^{[18
]}

Lindner, Matthias ^{[19
]}

Koulenti, Despoina ^{[20
,21
]}

Labeau, Sonia ^{[5
,22
]}

Lipman, Jeffrey ^{[23
,24
]}

Lipovestky, Fernando ^{[25
]}

Makikado, Luis Daniel Umezawa ^{[26
]}

Maseda, Emilio ^{[27
]}

Mikstacki, Adam ^{[28
,29
]}

Montravers, Philippe ^{[30
,31
]}

Paiva, Jose Artur ^{[32
]}

Pereyra, Cecilia ^{[33
]}

Rello, Jordi ^{[34
]}

Timsit, Jean-Francois ^{[35
,36
]}

Tomescu, Dana ^{[37
,38
]}

Vogelaers, Dirk ^{[5
,39
]}

Blot, Stijn ^{[5
,40
]}

机构：

[1] Papageorgiou Univ, Intens Care Unit, Affiliated Hosp, Thessaloniki, Greece

[2] Natl & Kapodistrian Univ Athens, Univ Hosp Attikon, Crit Care Dept, Athens, Greece

[3] Fdn Policlin Univ A Gemelli IRCCS, Dept Anaesthesiol Intens Care & Emergency Med, Rome, Italy

[4] Univ Cattolica Sacro Cuore, Rome, Italy

[5] Univ Ghent, Dept Internal Med & Paediat, Ghent, Belgium

[6] Royal Surrey Cty Hosp, Surrey Perioperat Anaesthet Crit Care Collaborat R, Guildford, England

[7] Univ Surrey, Dept Clin & Expt Med, Guildford, England

[8] Ghent Univ Hosp, Strateg Policy Cell, Ghent, Belgium

[9] Univ Utrecht, Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands

[10] Univ Queensland, Dept Crit Care Med, Brisbane, Australia

[11] Hop Bichat Claude Bernard, Med & Infect Dis ICU MI2, Dept Anaesthesiol & Reanimat, Paris, France

[12] Goettingen Univ, Dept Gen Visceral & Thorac Surg, Klinikum Hannoversch Muenden, Gottingen, Germany

[13] Shaare Zedek Med Ctr, Gen Intens Care Unit, Jerusalem, Israel

[14] Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel

[15] European Soc Intens Care Med, Div Sci Affairs Res, Brussels, Belgium

[16] Nykoebing Falster Hosp, Dept Anaesthesiol & Intens Care, Nykoebing Falster, Denmark

[17] Univ Hosp Modena, Anaesthesia & Intens Care Dept, Modena, Italy

[18] Univ Belgrade, Fac Med, Ctr Anaesthesia & Resuscitat, Clin Ctr Serbia, Belgrade, Serbia

[19] Univ Med Ctr Schleswig Holstein, Dept Anaesthesiol & Intens Care Med, Campus Kiel, Kiel, Germany

[20] Univ Queensland, Fac Med, Burns Trauma & Crit Care Res Ctr, Ctr Clin Res, Brisbane, Australia

[21] Attikon Univ Hosp, Crit Care Dept 2, Athens, Greece

[22] Univ Coll Ghent, Fac Educ Hlth & Social Work, Dept Nursing, Ghent, Belgium

[23] Jamieson Trauma Inst, Brisbane, Australia

[24] Univ Montpellier, Nimes Univ Hosp, Nimes, France

[25] Hosp Interamer Open Univ, Crit Care Dept, Buenos Aires, Argentina

[26] Clin Ricardo Palma, Unidad Cuidados Intens, Lima, Peru

[27] Hosp Univ La Paz IdiPaz, Dept Anaesthesia, Surg Crit Care, Madrid, Spain

[28] Poznan Univ Med Sci, Fac Hlth Sci, Poznan, Poland

[29] Reg Hosp Poznan, Dept Anaesthesiol & Intens Therapy, Poznan, Poland

[30] Univ Paris, NSERM UMR 1152, ANR10 LABX 17, Paris, France

[31] Hop Bichat Claude Bernard, AP HP, Dept Anaesthesiol & Crit Care Med, Paris, France

[32] Univ Porto, Ctr Hosp Univ S Joao, Fac Med, Intens Care Dept, Porto, Portugal

[33] Hosp Interzonal Gen Agudos Prof Dr Luis Guemes, Intens Care Unit, Buenos Aires, Argentina

[34] Ciberes & Vall dHebron Inst Res, Barcelona, Spain

[35] Univ Paris, IAME, INSERM, Paris, France

[36] AP HP, Paris, France

[37] Fundeni Clin Inst, Dept Anaesthesia & Crit Care, Bucharest, Romania

[38] Carol Davila Univ Med & Pharm, Bucharest, Romania

[39] AZ Delta, Dept Gen Internal Med & Infect Dis, Roeselare, Belgium

[40] Univ Ghent, Dept Internal Med & Paediat, Campus UZ Gent,Corneel Heymanslaan 10, B-9000 Ghent, Belgium

来源：

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS | 2022年 / 60卷 / 01期

关键词：

Intra-abdominal infection; Sepsis; Older adults; ICU; Mortality; BLOOD-STREAM INFECTIONS; LONG-TERM MORTALITY; ELDERLY-PATIENTS; RISK-FACTORS; CARE; PERITONITIS; DEFINITIONS; PREVALENCE; MANAGEMENT; IMPACT;

D O I：

10.1016/j.ijantimicag.2022.106591

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objective: To describe epidemiology and age-related mortality in critically ill older adults with intraabdominal infection.Methods: 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.Results: 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.Conclusions: 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.(c) 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.

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