ABSTRACT
BACKGROUND: Sepsis is prevalent in internal medicine (IM) departments. Elderly patients with sepsis and chronic medical conditions are at an increased risk for venous thromboemolism (VTE). The objective of this study was to assess the rate of VTE and the accuracy of the Padua Prediction Score (PPS) to predict VTE in patient with sepsis admitted to IM departments. METHODS: We prospectively collected data on septic patients admitted to IM departments in a community-based medical center. Additionally, we retrospectively collected VTE risk factors and events throughout a 1-year post hospitalization period. We computed the PPS for every patient, and analyzed the data accordingly. RESULTS: In total, 1080 patients were included in the study. The mean age was 74.68 ± 16.1 years. The average PPS was 4.86 ± 2.26, and 71.2% of the patients had a positive PPS. Only 17.8% of the patients received anticoagulant prophylaxis during their hospital stay. Seven patients had VTE on admission, 14 (1.29%) acquired in-hospital VTE, and 7 (0.65%) had VTE post discharge throughout 1 year. In all, 21.9% patients died during hospitalization, and the overall survival rate was 64%. PPS was not correlated with anticoagulant administration (P = 0.36), in-hospital VTE (P = 0.23) or 1-year VTE (P = 0.40), but was significantly associated with in-hospital death and survival (P < 0.0001). CONCLUSION: The rate of VTE in medical patients with sepsis in IM departments is low, and PPS lacks granularity in detecting patients at risk of acquiring it. In this population, a positive PPS is highly associated with death, and may reflect a more general co-morbidity and disease severity index.
Subject(s)
Hospital Departments , Internal Medicine , Patient Admission , Sepsis/epidemiology , Venous Thromboembolism/diagnosis , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Chi-Square Distribution , Comorbidity , Female , Hospital Mortality , Humans , Israel , Logistic Models , Male , Middle Aged , Multivariate Analysis , Patient Discharge , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors , Sepsis/diagnosis , Sepsis/mortality , Sepsis/therapy , Severity of Illness Index , Time Factors , Treatment Outcome , Venous Thromboembolism/drug therapy , Venous Thromboembolism/epidemiology , Venous Thromboembolism/mortality , Young AdultABSTRACT
BACKGROUND: Elderly patients are at a higher risk of acquiring sepsis, and are largely being treated in Internal Medicine (IM) departments. AIM: To characterize the differences between nonagenarians and other age groups in patients admitted to IM departments with sepsis, and to assess predictors for survival in patients older than 90 years of age. DESIGN AND METHODS: A prospective registry of all-comers with sepsis admitted to IM departments in a community-based Medical Center was build. Patients' demographics, medical history, clinical presentation and outcomes were recorded and analyzed according to age groups. RESULTS: One thousand and eighty patients were followed for a mean of 83.63 ± 65.90 days. Nonagenarians constituted 10.93% (118/1080) of our cohort. Of these, 70.48% had a cognitive impairment and 82.60% had reduced functional state. Of these, 5.61 and 10.50% fulfilled the criteria of septic shock and severe sepsis, respectively. Sepsis category was significantly influenced by age groups (P < 0.001). Complications secondary to sepsis at admission and throughout hospitalization, and mortality rates, were higher in the nonagenarian population (61.86 vs. 51.14%, P = 0.032 and 37.29 vs. 20.06%, P < 0.001, respectively), and overall survival was significantly lower in the nonagenarian population (40.68 vs. 66.84%, P < 0.001). CONCLUSION: Patients treated in IM departments for sepsis are old, and a significant percentage is older than 90 years of age with reduced function and mental status at baseline. These frail patients are afflicted by a worse outcome, which is most likely associated with poor functional status at baseline and severe deconditioning during the acute illness. Prognostic tools are needed to address today's trends in patient-mix and disease severity, specifically for very-old patients admitted with sepsis cared for in IM departments.
