Study on the nonlinear relationship between age and short-term mortality in systemic inflammatory response syndrom-negative septic patients
10.3760/cma.j.issn.0254-9026.2025.06.014
- VernacularTitle:全身炎症反应综合征阴性脓毒症患者年龄与短期病死率的非线性关系研究
- Author:
Chunyi FU
1
;
Lingling SU
;
Taotao LIU
Author Information
1. 北京医院保健医疗部 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Publication Type:Journal Article
- Keywords:
Sepsis;
Systemic inflammatory response syndrome;
Sequential organ failure assessment;
Fatality rate
- From:
Chinese Journal of Geriatrics
2025;44(6):755-760
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the nonlinear correlation and inflection points between age and short-term mortality in patients with negative systemic inflammatory response syndrome (SIRS)sepsis score.Methods:A retrospective cohort study was conducted using the medical information mart for intensive care Ⅳ(MIMIC-Ⅳ)database, which included adult patients with sepsis who were admitted to the intensive care unit(ICU)within 24 hours and did not receive mechanical ventilation or vasoactive drug, with a SIRS score ≤1.Patients were divided into survivors and non-survivors based on 28-day survival.Baseline variables such as age, gender, Charlson Comorbidity Index(CCI), body mass index(BMI), Sequential Organ Failure Assessment(SOFA)score, and initial lactate levels were compared between the two groups.With case fatality rate as the dependent variable, variables with differences in univariate analysis were incorporated into the binary logistic regression model, and baseline variables with statistically significant differences except age were matched according to the 1∶3 propensity score.Restricted cubic spline (RCS) regression was used to analyze the nonlinear relationship between patient age and mortality after matching and to determine the inflection point.Results:A total of 53 150 hospital records in the MIMIC-Ⅳ database were retrospectively screened, and 1 691 adult patients[aged(69.82±14.87)years]diagnosed with sepsis and negative SIRS score within 24 hours of ICU admission were included, with 101(5.97%)deaths within 28 days.Patients in the non-survivor group were older [(73.63±14.55)years vs.(69.58±14.86)years, t=-2.663, P=0.008], had higher CCI(4.38±2.64 vs.2.99±2.34, t=-5.732, P<0.001), and higher SOFA score (8.18±3.58 vs.5.04±2.67, t=-8.664, P<0.001)compared to the survivor group.There were no significant differences in gender, BMI, initial lactate levels, and the suspected infection sites (all P>0.05).Multivariable logistic regression analysis showed that increased age ( OR=1.03, 95% CI: 1.02-1.05, P<0.001), increased CCI ( OR=1.16, 95% CI: 1.06-1.26, P<0.001), and increased SOFA score ( OR=1.34, 95% CI: 1.26-1.43, P<0.001)were significantly associated with increased mortality in patients with negative SIRS score.After including SOFA score and CCI in the propensity score matching, there were 271 survivors and 93 non-survivors.RCS results showed a non-linear association between age and mortality( Poverall=0.001, Pnon-linear=0.001), with a significant increase in the OR for mortality when age exceeded 73 years. Conclusions:In sepsis patients with comparable organ function, the short-term mortality rate of patients with negative SIRS score increases non-linearly with age.These patients have mild symptoms but poor clinical outcomes, necessitating early and enhanced monitoring when age exceeds 73 years.
