Sepsis and septic shock in geriatrics
Abstract
Sepsis is a potentially life-threatening condition that poses diagnostic challenges, particularly in the older population. Clinical manifestations of sepsis in these individuals can be blurred and atypical, making detection and diagnosis difficult. Common symptoms such as fever may be absent; conversely, older patients may present with atypical signs such as delirium, altered mental status, falls, weakness, and urinary incontinence. This can lead to delayed diagnosis, which increases the risk of rapid progression to septic shock. To improve diagnostic accuracy, various laboratory biomarkers and clinical scores have been developed, such as the Sequential (Sepsis-related) Organ Failure Assessment Score (SOFA-score), quick SOFA (qSOFA), and geriatric-qSOFA. These tools aid in identifying sepsis and predicting mortality risk promptly. In terms of treatment, early intervention is crucial. Maintaining adequate tissue perfusion (“fluid resuscitation”), appropriate antibiotic therapy, and eventually vasopressor support are key components of sepsis management in older adults. Additionally, in frail and comorbid patients, priority must be given to supportive care aimed at enhancing quality of life. Tailored therapeutic interventions are crucial to improving outcomes in this vulnerable population.
Keywords
References
- Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801-10. DOI: https://doi.org/10.1001/jama.2016.0287
- Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020;395:200-11. DOI: https://doi.org/10.1016/S0140-6736(19)32989-7
- Remelli F, Fogagnolo A, Zurlo A, et al. Prognostic factors in older patients admitted in ICU with diagnosis of abdominal sepsis (sepsis-3 criteria). JGG 2020;68:152-8. DOI: https://doi.org/10.36150/2499-6564-391
- Rowe T, Araujo KL, Van Ness PH, et al. Outcomes of older adults with sepsis at admission to an intensive care unit. Open Forum Infect Dis 2016;3:ofw010. DOI: https://doi.org/10.1093/ofid/ofw010
- Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 2016;193:259-72. DOI: https://doi.org/10.1164/rccm.201504-0781OC
- Nasa P, Juneja D, Singh O. Severe sepsis and septic shock in the elderly: an overview. World J Crit Care Med 2012;1:23-30. DOI: https://doi.org/10.5492/wjccm.v1.i1.23
- Vincent JL, De Backer D. Circulatory Shock N Engl J Med 2013;369:1726-34. DOI: https://doi.org/10.1056/NEJMra1208943
- Preau S, Vodovar D, Jung B et al. Energetic dysfunction in sepsis: a narrative review. Ann Intensive Care 2021;11:104. DOI: https://doi.org/10.1186/s13613-021-00893-7
- Chung HY, Wickel J, Brunkhorst FM, et al. Sepsis-associated encephalopathy: from delirium to dementia? J Clin Med 2020;9:703. DOI: https://doi.org/10.3390/jcm9030703
- Czempik PF, Pluta MP, Krzych ŁJ. Sepsis-associated brain dysfunction: a review of current literature. Int J Environ Res Public Health 2020;17:5852. DOI: https://doi.org/10.3390/ijerph17165852
- Mazeraud A, Righy C, Bouchereau E, et al. Septic-associated encephalopathy: a comprehensive review. Neurotherapeutics 2020;17:392-403. DOI: https://doi.org/10.1007/s13311-020-00862-1
- Carbone F, Liberale L, Preda A, et al. Septic cardiomyopathy: from pathophysiology to the clinical setting. Cells 2022;11:2833. DOI: https://doi.org/10.3390/cells11182833
- Mankowski RT, Laitano O, Clanton TL, et al. Pathophysiology and treatment strategies of acute myopathy and muscle wasting after sepsis. J Clin Med 2021;10:1874. DOI: https://doi.org/10.3390/jcm10091874
- Iba T, Umemura Y, Wada H, et al. Roles of coagulation abnormalities and microthrombosis in sepsis: pathophysiology, diagnosis, and treatment. Arch Med Res 2021;52:788-97. DOI: https://doi.org/10.1016/j.arcmed.2021.07.003
- Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev 2016;31:1-8. DOI: https://doi.org/10.1016/j.arr.2016.08.006
- Ramoni D, Tirandi A, Montecucco F, Liberale L. Sepsis in elderly patients: the role of neutrophils in pathophysiology and therapy. Intern Emerg Med 2024;19:901-17. DOI: https://doi.org/10.1007/s11739-023-03515-1
- Clifford KM, Dy-Boarman EA, Haase KK, et al. Challenges with diagnosing and managing sepsis in older adults. Expert Rev Anti Infect Ther 2016;14:231-41. DOI: https://doi.org/10.1586/14787210.2016.1135052
- Lee HY, Lee J, Jung YS, et al. Preexisting clinical frailty is associated with worse clinical outcomes in patients with sepsis. Crit Care Med 2022;50:780-90. DOI: https://doi.org/10.1097/CCM.0000000000005360
- Church S, Rogers E, Rockwood K, Theou O. A scoping review of the clinical frailty scale. BMC Geriatr 2020;20:393. DOI: https://doi.org/10.1186/s12877-020-01801-7
- Von Groote T, Meersch-Dini M. Biomarkers for the prediction and judgement of sepsis and sepsis complications: a step towards precision medicine? J Clin Med 2022;11:5782. DOI: https://doi.org/10.3390/jcm11195782
- Sullivan RC, Rockstrom MD, Schmidt EP, et al. Endothelial glycocalyx degradation during sepsis: causes and consequences. Matrix Biol Plus 2021;12:100094. DOI: https://doi.org/10.1016/j.mbplus.2021.100094
- Tang Y, Fung E, Xu A, Lan HY. C-reactive protein and ageing. Clin Exp Pharmacol Physiol 2017;44:9-14. DOI: https://doi.org/10.1111/1440-1681.12758
- Lo Buglio A, Bellanti F, Talia M, et al. Reliability of serum procalcitonin concentration for the diagnosis of sepsis in elderly patient with chronic kidney disease. JGG 2016;64:49-54.
- Thomas-Rüddel DO, Poidinger B, Kott M, et al. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care 2018;22:128. DOI: https://doi.org/10.1186/s13054-018-2050-9
- Hatzistilianou M. Diagnostic and prognostic role of procalcitonin in infections. ScientificWorldJournal 2010;10:1941-6. DOI: https://doi.org/10.1100/tsw.2010.181
- Wirz Y, Meier MA, Bouadma L, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care 2018;22:191. DOI: https://doi.org/10.1186/s13054-018-2125-7
- Heilmann E, Gregoriano C, Annane D, et al. Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials. Age Ageing 2021;50:1546-56. DOI: https://doi.org/10.1093/ageing/afab078
- Falcone M, Bauer M, Ferrer R, et al. Biomarkers for risk stratification and antibiotic stewardship in elderly patients. Aging Clin Exp Res 2023;35:925-35. DOI: https://doi.org/10.1007/s40520-023-02388-w
- Zhao Y, Li C. Diagnostic value of a combination of biomarkers in patients with sepsis and severe sepsis in emergency department. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2014;26:153-8. [Article in Chinese].
- Ahuja N, Mishra A, Gupta R, Ray S. Biomarkers in sepsis-looking for the holy grail or chasing a mirage! World J Crit Care Med 2023;12:188-203. DOI: https://doi.org/10.5492/wjccm.v12.i4.188
- Pilotto A, Dini S, Daragjati J, et al. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study. Aging Clin Exp Res 2018;30:193-7. DOI: https://doi.org/10.1007/s40520-017-0759-y
- Liu B, Chen YX, Yin Q, et al. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Crit Care 2013;17:R244. DOI: https://doi.org/10.1186/cc13070
- Christ-Crain M, Morgenthaler NG, Stolz D, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006;10:R96. DOI: https://doi.org/10.1186/cc4955
- Li Q, Wang BS, Yang L, et al. Assessment of adrenomedullin and proadrenomedullin as predictors of mortality in septic patients: a systematic review and meta-analysis. Med Intensiva 2018;42:416-24. DOI: https://doi.org/10.1016/j.medin.2017.10.013
- Huang Q, Xiong H, Yan P, et al. The diagnostic and prognostic value of suPAR in patients with sepsis: a systematic review and meta-analysis. Shock 2020;53:416-25. DOI: https://doi.org/10.1097/SHK.0000000000001434
- Zhao J, Zhang Y, Wang JY, et al. Correlation analyses between serum interleukin-7, interleukin-15 and lactate provide insights into their potential roles in the regulation of inflammation in elderly septic patients. Biomark Insights 2024;19:11772719241275525. DOI: https://doi.org/10.1177/11772719241275525
- Kumar NR, Balraj TA, Shivashankar KK, et al. Inflammaging in multidrug-resistant sepsis of geriatric ICU patients and healthcare challenges. Geriatrics 2024;9:45. DOI: https://doi.org/10.3390/geriatrics9020045
- Ibarz M, Haas LEM, Ceccato A, Artigas A. The critically ill older patient with sepsis: a narrative review. Ann Intensive Care 2024;14:6. DOI: https://doi.org/10.1186/s13613-023-01233-7
- Liu C, Suo S, Luo L, et al. SOFA score in relation to sepsis: clinical implications in diagnosis, treatment, and prognostic assessment. Comput Math Methods Med 2022;2022:7870434. Retraction in: Comput Math Methods Med 2023;2023:9856196. DOI: https://doi.org/10.1155/2022/7870434
- Remelli F, Castellucci F, Vitali A, et al. Predictive value of geriatric-quickSOFA in hospitalized older people with sepsis. BMC Geriatr 2021;21:241. DOI: https://doi.org/10.1186/s12877-021-02182-1
- Moreno R, Rhodes A, Piquilloud L, et al. The sequential organ failure assessment (SOFA) score: has the time come for an update? Crit Care 2023;27:15. DOI: https://doi.org/10.1186/s13054-023-04468-9
- Bastoni D, Ticinesi A, Lauretani F, et al. Application of the sepsis-3 consensus criteria in a geriatric acute care unit: a prospective study. J Clin Med 2019;8:359. DOI: https://doi.org/10.3390/jcm8030359
- Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care 2008;12:R161. DOI: https://doi.org/10.1186/cc7160
- Falsetti L, Martino M, Zaccone V, et al. SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine. Infection 2020;48:879-87. DOI: https://doi.org/10.1007/s15010-020-01494-5
- Ramos-Rincón JM, Fernández-Gil A, Merino E, et al. The quick sepsis-related organ failure assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: a retrospective observational study. Sci Rep 2019;9:15075. DOI: https://doi.org/10.1038/s41598-019-51439-8
- Goodacre S, Fuller G, Conroy S, Hendrikse C. Diagnosis and management of sepsis in the older adult. BMJ 2023;382:e075585. DOI: https://doi.org/10.1136/bmj-2023-075585
- Evans L, Rhodes A, Alhazzani W, et al. surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181-247. DOI: https://doi.org/10.1007/s00134-021-06506-y
- Brown RM, Semler MW. Fluid management in sepsis. J Intensive Care Med 2019;34:364-73. DOI: https://doi.org/10.1177/0885066618784861
- Caironi P, Tognoni G, Masson S, et al; ALBIOS study investigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014;370:1412-21. DOI: https://doi.org/10.1056/NEJMoa1305727
- Lesur O, Delile E, Asfar P, et al. Hemodynamic support in the early phase of septic shock: a review of challenges and unanswered questions. Ann Intensive Care 2018;8:102. DOI: https://doi.org/10.1186/s13613-018-0449-8
- IDSA Sepsis Task Force. Infectious Diseases Society of America (IDSA) POSITION STATEMENT: why IDSA did not endorse the surviving sepsis campaign guidelines. Clin Infect Dis 2018;66:1631-5. DOI: https://doi.org/10.1093/cid/cix997
- Sulis G, Sayood S, Katukoori S, et al. Exposure to World Health Organization’s AWaRe antibiotics and isolation of multidrug resistant bacteria: a systematic review and meta-analysis. Clin Microbiol Infect 2022;28:1193-202. DOI: https://doi.org/10.1016/j.cmi.2022.03.014
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