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P0497 SEPSIS EVENTS IN A VERY OLD POPULATION
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 P0496
S165
Table 1. Mortality, recurrent events, adverse reaction to anticoagulat therapy
VENOUS THROMBOEMBOLIC DISEASE: A COHORT FOLLOW UP
Diego Giunta, Cristina Elizondo, Mariela Baleiron, Carlos Millan Ramos, Nora Fuentes, Valeria Pazo, Fernando Vazquez, Fernan Bernaldo Delquiros, Gabriel Waisman. Hospital Italiano De Buenos Aires Background: Venous thromboembolic disease is a frequent entity with high immediate and long-term mortality. Pulmonary embolism (PE) is associated with a mortality rate of approximately 30 percent without treatment, primarily as the result of recurrent embolism. However, accurate diagnosis followed by effective anticoagulation therapy decreases the mortality rate to 2 to 8 percent. Aim: Compare mortality rates in patients with documented DVT/ PE and patients with suspected PE but without PE or DVT. Methods: Cohort of patients included in the Venous Thromboembolic Disease Institutional Registry of the Hospital Italiano de Buenos Aires between July 2006 and January 2008. Inclusion criteria were adults belonging to one of the three following groups: 1. suspected PE but ruled out by complementary studies (SPE); 2. documented Deep Vein Thrombosis (DVT); or 3. documented Pulmonary Embolism (PE). We performed a six month periodicity follow up consisting of careful systematic structured revision of electronic medical records and telephonic evaluation with direct interview to detect death, recurrent events, as well as any adverse reaction related to anticoagulant therapy. Follow up period began at the time of diagnosis. We calculated for confirmed venous thromboembolic disease (grouped DVT and PE) hazard ratios for mortality, adjusted by age, gender, Charlson comorbidity score and cancer, using Cox proportional hazard regression analysis. Results: 514 patients were included in the Registry in the period considered, 161 with SPE, 257 DVT, and 96 PE. We found no statistical significant differences in age (67, 71 and 70 years, p 0.5), female proportion (59%, 52% and 54%, p 0.38), Charlson comorbidity score (2, 2 and 1, p 0.12) and cancer (38%, 41% and 36%, p 0.69) in the three groups. Observed mortality was 64 (40%), 90 (35%) and 35 (36.5%) in the SPE, DVT and PE groups respectively (p 0.619) (Table1). 18 months estimated survival rate was 60% (95%CI 48 - 70) in SPE, 63% (95%CI 55 - 70) in DVT and 62% (95%CI 49 - 74) in PE with overlapping 95%CI (p 0.52). Adjusted hazard ratio for mortality for confirmed venous thromboembolic disease was 0.83 (95%CI 0.62 - 1.13) (Figure 1).
suspicion of thromboembolic disease at baseline, associated with permanent hypercoagulable state. This might be the main limitation of our study.
P0497 SEPSIS EVENTS IN A VERY OLD POPULATION
Diego Giunta, Cristina Elizondo, Ariel De Toma, Nora Fuentes, Valeria Pazo, Javier Pollan, Sergio Giannasi, Estela Salazar, Fernan Bernaldo De Quiros, Gabriel Waisman. Hospital Italiano De Buenos Aires Background: Septic patients are known to have early elevated risk of death which is sustained for years after the septic event, diminishing life expectancy and deteriorating quality of life and functionality. Aim: To describe the overall characteristics of a group of patients older than 75 years admitted with a septic event compared to a group of septic patients younger than 75 years. Methods: Descriptive, cross-sectional study. We prospectively included patients, affiliated to an HMO (120000 affiliates) of a Community Hospital, admitted with an episode of sepsis from November 2007 to June 2008. We considered two groups of patients: older (O75) and younger (Y75) than 75. Results: We included 572 patients, 363 O75 and 209 Y75. In the first group the median age was 84 and 59% were women. The second group had a median age of 63 and, 47% were women. The Charlson comorbidity score was of 1 and 2 for Y75 and O75 respectively. The O75 had significantly more comorbidities when compared to the Y75 (Table1). In both groups the most frequent sites of infection were the respiratory and urinary tract: 47% and 27% in the O75 and 41% y 23% in the Y75. In the O75 group septic shock was diagnosed in 11.6% of the patients, severe sepsis in 36.2% and multi-organ failure in 18%. In the Y75 group septic shock was present in 11% of the patients, 36% had severe sepsis, and 20% had multi-organ failure. The in-hospital mortality was 22.4% in the O75 and 16,5% in the Y75, with a median hospital stay of 8 and 9 days respectively. In the univariate analysis we did not find statistical differences in septic shock proportion (p0.80), multi- organ failure (p0.56), or resistant germ (p 0.39). In multivariate analysis the in-hospital mortality odds for the O75 was 1.95 (p 0.01) when we adjust by gender, Charlson comorbidity score, severe sepsis and positive blood cultures. Table 1. Basal characteristics
Figure 1. Hazard ratios. TD: Thromboembolic disease.
Discussion: We did not find any difference in survivorship in the three groups, or between confirmed venous thromboembolic disease and Suspected PE. In our cohort, the main factors associated with mortality are age, Charlson comorbidity score, and cancer (including new diagnosis during the follow up period). We could not find any difference in adjusted hazard ratios for mortality. These results might not be extrapolable to the general population since our comparison group represents a special subgroup of patients with a high
Discussion: The O75 group was found to have more comorbidities compared to the general population. Mortality in our sample was inferior compared to other studies. Being O75 years has 1.95 more risk of dying during a septic event adjusting mortality for severity and morbidity.
S165
Table 1. Mortality, recurrent events, adverse reaction to anticoagulat therapy
VENOUS THROMBOEMBOLIC DISEASE: A COHORT FOLLOW UP
Diego Giunta, Cristina Elizondo, Mariela Baleiron, Carlos Millan Ramos, Nora Fuentes, Valeria Pazo, Fernando Vazquez, Fernan Bernaldo Delquiros, Gabriel Waisman. Hospital Italiano De Buenos Aires Background: Venous thromboembolic disease is a frequent entity with high immediate and long-term mortality. Pulmonary embolism (PE) is associated with a mortality rate of approximately 30 percent without treatment, primarily as the result of recurrent embolism. However, accurate diagnosis followed by effective anticoagulation therapy decreases the mortality rate to 2 to 8 percent. Aim: Compare mortality rates in patients with documented DVT/ PE and patients with suspected PE but without PE or DVT. Methods: Cohort of patients included in the Venous Thromboembolic Disease Institutional Registry of the Hospital Italiano de Buenos Aires between July 2006 and January 2008. Inclusion criteria were adults belonging to one of the three following groups: 1. suspected PE but ruled out by complementary studies (SPE); 2. documented Deep Vein Thrombosis (DVT); or 3. documented Pulmonary Embolism (PE). We performed a six month periodicity follow up consisting of careful systematic structured revision of electronic medical records and telephonic evaluation with direct interview to detect death, recurrent events, as well as any adverse reaction related to anticoagulant therapy. Follow up period began at the time of diagnosis. We calculated for confirmed venous thromboembolic disease (grouped DVT and PE) hazard ratios for mortality, adjusted by age, gender, Charlson comorbidity score and cancer, using Cox proportional hazard regression analysis. Results: 514 patients were included in the Registry in the period considered, 161 with SPE, 257 DVT, and 96 PE. We found no statistical significant differences in age (67, 71 and 70 years, p 0.5), female proportion (59%, 52% and 54%, p 0.38), Charlson comorbidity score (2, 2 and 1, p 0.12) and cancer (38%, 41% and 36%, p 0.69) in the three groups. Observed mortality was 64 (40%), 90 (35%) and 35 (36.5%) in the SPE, DVT and PE groups respectively (p 0.619) (Table1). 18 months estimated survival rate was 60% (95%CI 48 - 70) in SPE, 63% (95%CI 55 - 70) in DVT and 62% (95%CI 49 - 74) in PE with overlapping 95%CI (p 0.52). Adjusted hazard ratio for mortality for confirmed venous thromboembolic disease was 0.83 (95%CI 0.62 - 1.13) (Figure 1).
suspicion of thromboembolic disease at baseline, associated with permanent hypercoagulable state. This might be the main limitation of our study.
P0497 SEPSIS EVENTS IN A VERY OLD POPULATION
Diego Giunta, Cristina Elizondo, Ariel De Toma, Nora Fuentes, Valeria Pazo, Javier Pollan, Sergio Giannasi, Estela Salazar, Fernan Bernaldo De Quiros, Gabriel Waisman. Hospital Italiano De Buenos Aires Background: Septic patients are known to have early elevated risk of death which is sustained for years after the septic event, diminishing life expectancy and deteriorating quality of life and functionality. Aim: To describe the overall characteristics of a group of patients older than 75 years admitted with a septic event compared to a group of septic patients younger than 75 years. Methods: Descriptive, cross-sectional study. We prospectively included patients, affiliated to an HMO (120000 affiliates) of a Community Hospital, admitted with an episode of sepsis from November 2007 to June 2008. We considered two groups of patients: older (O75) and younger (Y75) than 75. Results: We included 572 patients, 363 O75 and 209 Y75. In the first group the median age was 84 and 59% were women. The second group had a median age of 63 and, 47% were women. The Charlson comorbidity score was of 1 and 2 for Y75 and O75 respectively. The O75 had significantly more comorbidities when compared to the Y75 (Table1). In both groups the most frequent sites of infection were the respiratory and urinary tract: 47% and 27% in the O75 and 41% y 23% in the Y75. In the O75 group septic shock was diagnosed in 11.6% of the patients, severe sepsis in 36.2% and multi-organ failure in 18%. In the Y75 group septic shock was present in 11% of the patients, 36% had severe sepsis, and 20% had multi-organ failure. The in-hospital mortality was 22.4% in the O75 and 16,5% in the Y75, with a median hospital stay of 8 and 9 days respectively. In the univariate analysis we did not find statistical differences in septic shock proportion (p0.80), multi- organ failure (p0.56), or resistant germ (p 0.39). In multivariate analysis the in-hospital mortality odds for the O75 was 1.95 (p 0.01) when we adjust by gender, Charlson comorbidity score, severe sepsis and positive blood cultures. Table 1. Basal characteristics
Figure 1. Hazard ratios. TD: Thromboembolic disease.
Discussion: We did not find any difference in survivorship in the three groups, or between confirmed venous thromboembolic disease and Suspected PE. In our cohort, the main factors associated with mortality are age, Charlson comorbidity score, and cancer (including new diagnosis during the follow up period). We could not find any difference in adjusted hazard ratios for mortality. These results might not be extrapolable to the general population since our comparison group represents a special subgroup of patients with a high
Discussion: The O75 group was found to have more comorbidities compared to the general population. Mortality in our sample was inferior compared to other studies. Being O75 years has 1.95 more risk of dying during a septic event adjusting mortality for severity and morbidity.