Mortality Risk Factors at Time on ED Admission in Elderly Patients with Infectious Diseases

Abstract

Background: As elderly individuals often exhibit heightened vulnerability to infections due to factors such as compromised immune systems, chronic illnesses, and age-related physiological changes, understanding the characteristics and risk factors associated with infectious diseases in this population is crucial. The aim of the present study was to evaluate the characteristics of elderly patients with infectious disease in ED admission and to identify risk factors that influence in-hospital mortality. Material and Method: In this study, we enrolled 448 adult patients diagnosed with infectious diseases such as pneumonia, urinary tract infection, gastroenteritis, meningitis, and cellulitis. The participants were directly admitted to our Emergency Department (ED) from their homes or their relatives' residences between November 1, 2014, and May 31, 2015. We investigated patient’s vital signs, disease signs, source of infection, length of staying at hospital, length of staying at emergency service, mortality related scores, laboratory data, treatment and prognosis. Results and Conclusion: The rate of emergency care admissions with an infectious etiology was found as 17%. Average age of patients was 76±8 with 180 (40%) of them being female and 268 (60%) of them being male. Mortality rate was found as 23%. Cox regression analysis concluded that for 65 years or older patients, risk factors that effected mortality were; septic shock, cardiac disease and presence of malignancy, absence of COPD/Asthma, higher pCO2 and lower HCO3 at the time of admission to the emergency service. Calculating MEDS score and APACHE 2 score at admission to the emergency department and intensive care unit can facilitate early intervention, improving recovery prospects. Further research and clinical strategies may benefit from these identified predictors to improve the management and outcomes of elderly patients with infectious diseases in the ED.

Keywords

• Mortality
• Infectious Diseases
• Elderly patients

References

1. 1. Mathers CD, Stevens GA, Boerma T, White RA. Tobias MI. Causes of international increases in older age life expectancy. Lancet 2015;385:540-548
2. 2. Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontol 2000. 2016;72(1):153–175.
3. 3. Fabbri LM, Luppi F, Beghe B, Rabe KF. Update in chronic obstructive pulmonary disease 2005. Am J Respir Crit Care Med 2006;173:1056–1065.
4. 4. Heppner HJ, Cornel S, Peter W, Bahrmann P, Singler K. Infections in the elderly. Crit Care Clin 2013;29:757–74
5. 5. Bunawan NC, Rizka A. "Diagnostic and Prognostic Value of Procalcitonin for Bacterial Infection in the Elderly." International Journal of Medical Reviews and Case Reports 2021;5(8):14
6. 6. Landi F, Calvani R, Tosato M, Martone AM. Ortolani E, Savera G, Sisto A. Marzetti E. Anorexia of aging: Risk factors, consequences, and potential treatments. Nutrients 2016;8:69
7. 7. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-84
8. 8. Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med. 2003;31(3):670–5.

9. 9. Ittisanyakorn M, Ruchichanantakul S, Vanichkulbodee A, et al.. Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country. BMC Infect Dis. 2019;19:662
10. 10. Goto T, Yoshida K, Tsugawa Y, Camargo CA, Jr, Hasegawa K. 2016. Infectious disease-related emergency department visits of elderly adults in the United States, 2011-2012. J Am Geriatr Soc 64:31–36
11. 11. Holman RC, Curns AT, Singleton RF, et al. Infectious disease hospitalizations among older American Indian and Alaska Native adults. Public Health Rep. 2006;121(6):674–683
12. 12. da Silva NCZ, da Rocha JA, do Valle FM, Silva ASDN, Ehrlich S, Martins IS. The impact of ageing on the incidence and mortality rate of bloodstream infection: A hospital-based case-cohort study in a tertiary public hospital of Brazil. Trop Med Int Health. 2021;26(10):1276–84.
13. 13. Schoevaerdts D, Sibille F-X, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res. 2021;33(3):689–701.
14. 14. Singhal S, Kumar P, Singh S, Saha S, Dey AB. Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis. BMC Geriatr. 2021;21(1):321
15. 15. Mukherjee K, Burruss SK, Brooks SE, May AK. Managing infectious disease in the critically ill elderly patient. Current Geriatrics Reports. 2019;8:180-193
16. 16. McLeod JC, Stokes T, Phillips SM. Resistance exercise training as a primary countermeasure to age-related chronic disease. Front. Physiol. 2019;10:645
17. 17. Gavazzi G, Krause KH, Ageing and infection. The Lancet Infect Dis 2002; 2(11):659-66.
18. 18. High KP. Infection as a cause of age-related morbidity and mortality. Ageing Research Reviews 2004;3(1):1-14.