Abstract
Objective: The incidence of sepsis in older adults has been increasing with the general aging of the Japanese population. However, it has been shown that age is a critical factor in determining both the risk for sepsis and subsequent vital outcomes; aggressive treatment is often discouraged in this vulnerable patient group. This study aimed to determine whether aggressive therapeutic interventions were associated with mortality in older Japanese patients experiencing septic shock.
Design: Single-center retrospective cohort study.
Setting: Medical Intensive Care Unit of a city hospital (Kishiwada Tokushukai Hospital) in Japan between January 2020 and September 2021.
Patients: Patients diagnosed with septic shock at the time of admission and older patients over 65 years of age were included and divided into two groups: a withholding group that received only minimal peripheral infusion and antibiotic therapy and a treatment group (non-withholding group) that received intensive care, such as vasopressor use or mechanical ventilator management.
Interventions: None.
Measurements and results: One hundred patients were included in this study. There were 13 and 87 patients in the withholding and non-withholding groups, respectively.
There was no significant difference in 30-day mortality between the two groups (53.85% vs 39.08%, p=0.127). However, the 72-hour mortality was significantly higher in the withholding group (53.8% vs 25.3%, p=0.034).
Conclusions: Among older patients with septic shock, the withholding group showed a survival rate that was not significantly different from that of the non-withholding group. On the other hand, some level of survival may be expected in patients who withhold treatment after 72 hours or more. Further studies are needed to determine the impact of withholding treatment on patients, not only in terms of mortality but also in terms of long-term prognosis and activities of daily living after discharge from the hospital.
Daisuke Hirano, Masahiro Shinozaki, Arito Kaji
