STUDY OF CLINICAL PROFILE, RISK FACTORS AND OUTCOME OF SEPSIS IN ELDERLY

Dr. Arun V.G.*, Dr. Venkatarathnamma P.N., Dr. Prabhakar K. and Dr. Reddy Prasad

ABSTRACT

Introduction: Sepsis is the most common cause for hospitalization in the ICU around the world. The clinical presentation of older patients with sepsis is often atypical, leading to a difficult and delayed diagnosis. Prompt diagnosis is crucial to the management of sepsis, as initiation of early-goal-directed therapy is the key to reducing mortality from severe sepsis especially in older patients. Unless antibiotics and life support are delivered quickly, the condition can lead to organ failure and death. Objectives: To study the risk factors and clinical profile of sepsis in elderly. To record the primary site of infection and to determine the influence of sepsis on the survival outcome in the elderly. Materials and methods: A hospital based observational study was conducted on patients admitted to R.L. Jalappa Hospital & Research Centre attached to Sri Devaraj Urs Medical College, Tamaka, Kolar. 100 Patients ≥ 65 years of age admitted with a clinical suspicion of sepsis and those fulfilling the criteria for sepsis by PIRO grading system who gives informed consent for the study. Patients are to be divided into groups based on their age. All patients’ clinical presentation, previous medical history and outcomes as death/discharge and duration of hospital stay are to be recorded and analysed according to the age groups. Results: 100 subject studied, 64 were males and commonly seen in the age group 65 – 74yrs. Mean hospital stay in pts was 5.1 days with SD 5.2 days. Fever (71%) was the common symptom followed by cough (40%). Diabetes was the most common risk factor followed by hypertension. Only 30% of the patients were found to be febrile at the time of presentation. Most common site of infection was respiratory system (57%) followed by neuroinfection (33%). Nine percent patients had no Foci of infection, 42% had one foci, 45% had 2 foci and 4% had 3 foci of infection. 54.7% of Males there were 2 foci of infection and in females 55.6% had one focus of infection. 38% of pts had shock at the time of presentation or during their course in the hospital. There was significant association between Respiratory site, UTI and outcome. Among 23 subjects who died, 73.9% had respiratory infections. 52% of subjects were discharged, 25% Discharged against Medical advice (DAMA) and 23% had mortality. Conclusion: Sepsis is more commonly seen in males than in females. Fever being the most common presenting symptom. Elderly patients can develop sepsis even without fever which was seen in 29% of the patients in this study. Respiratory system was found to be the most common site of infection. A significant number of patients developed complications in the form of ICU admission, Ventilator support, acute renal failure and septic shock. There was significant association between Respiratory foci and complications such as Shock and ICU admission and a significant association between ARF and Cellulitis was also seen.

Keywords: neuroinfection, Discharged against Medical advice (DAMA).