Nationwide Trend of Sepsis: A Comparison Among Octogenarians, Elderly, and Young Adults

Objective: We aimed to compare the sepsis incidence, mortality rates, and primary sites of infection among adult, elderly, and octogenarian patients with sepsis. Design: Population-based cohort study. Setting: The entire health insurance claims data of Taiwan, which enrolled 99.8% of the 23 million Taiwanese population. Patients: Sepsis patients were identified by International Classification of Diseases, 9th Edition, Clinical Modification codes for both infection and organ dysfunction from January 1, 2002, to December 31, 2012. Patients were categorized into three age groups: 1) adults (18–64 yr); 2) elderly (65–84 yr); and 3) oldest old (≥ 85 yr). The 30-day all-cause mortality was verified by a linked national death certificate database. Interventions: None. Measurements and Main Results: From 2002 to 2012, we identified 1,259,578 patients with sepsis, of which 417,328 (33.1%) were adults, 652,618 (51.8%) were elderly, and 189,632 (15.1%) were oldest old. We determined that the incidence of sepsis in the oldest old was 9,414 cases per 100,000 population on 2012, which was 31-fold greater than the adult incidence (303 cases per 100,000 population) and three-fold greater than the elderly incidence (2,908 cases per 100,000 population). Despite the increasing trend in incidence, the mortality decreased by 34% for adults, 24% for elderly, and 22% for oldest old. However, systemic fungal infection was disproportionately increased in oldest old patients (1.76% annual increase) and the elderly patients (1.00% annual increase). Conclusion: The incidence of sepsis is disproportionately increased in elderly and oldest old patients. Despite the increasing trend in incidence, the mortality rate in geriatric patients with sepsis has decreased. However, the increased incidence of fungal infections in the geriatric population warrants further attention. Additional members of the National Taiwan University Health Economics and Outcome Research Group are: Meng-Che Wu, Shyr-Chyr Chen, Wan-Ting Hsu, Szu-Ta Chen, and Ke-ying Su. No funding bodies had any role in the study design, data collection and analysis, decision to publish, or preparation of the article. The interpretation and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health, or National Health Research Institutes. Dr. S.-H. Lee drafted the analytical plan, guided the statistical analysis, interpreted the data, and wrote the draft. Ms. Hsu and Ms. W.-C. Lee conducted all the statistical analysis. Dr. M.-t.G. Lee interpreted the results, and wrote the final draft and point-to-point response. Dr. Chao helped with language editing and provided critical comments. Dr. Lai analyzed the data, provided critical feedback, and authorized the final article. Dr. C.-C. Lee designed the study, obtained funding, drafted the analytical plan, guided the statistical analysis, interpreted the data, and wrote the draft. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/29S62lw). Supported, in part, by the Taiwan National Science Foundation Grant NSC 102-2314-B-002 -131 -MY3, National Taiwan University Hospital Grant NTUH.106-P04, and Taiwan National Ministry of Science and Technology Grants MOST 104-2314-B-002 -039 -MY3 and MOST 106-2811-B-002-048. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: cclee100@gmail.com Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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