Prognostic factors for mortality in age-stratified elderly sepsis patients: A retrospective cohort study based on the MIMIC-IV database

Clinical Snapshot

Key Findings

• P Value: Not specified in abstract

• Effect Size: Oliguria associated with 2.5-fold increase in mortality risk in older patients

• Primary Outcome: 28-day mortality in age-stratified elderly sepsis patients

• Nnt Or Sensitivity: Age-specific prognostic factors: LDH and PaO2/FiO2 ratio in younger-old; urea nitrogen and hypoalbuminemia in older-old groups

• Confidence Interval: Not specified in abstract

Clinical Application

Highly feasible as uses readily available clinical and biochemical markers in ICU setting Directly applicable to Australian ICUs; aligns with ANZICS sepsis guidelines and could inform risk stratification in elderly patients under Medicare-funded intensive care Elderly sepsis patients aged 60+ years in intensive care settings

Abstract

Sepsis represents a major cause of death among elderly patients; however, prognostic factors specific to different age strata within this population remain insufficiently characterized. This retrospective cohort study aimed to identify early predictors of mortality in elderly sepsis patients using the MIMIC-IV database. We included 13,461 sepsis patients aged ≥60 years, stratified into younger-old (60-74 years; n = 7618) and older-old (75-90 years; n = 5843) groups. Propensity score matching was applied to balance baseline characteristics, yielding 4657 matched patients per group. Multivariable logistic regression, receiver operating characteristic analysis, and Kaplan-Meier survival curves were employed to assess clinical and biochemical markers for 28-day mortality and to identify age-specific prognostic indicators. These findings underscore the importance of age-stratified prognostic models to guide targeted clinical interventions and potentially improve outcomes in elderly patients with sepsis. Lactate dehydrogenase (LDH) and the PaO2/FiO2 ratio emerged as key mortality predictors in the younger-old group, whereas urea nitrogen and hypoalbuminemia were predominant in the older-old group. Urine output served as a common predictor across both strata, with oliguria associated with a 2.5-fold increase in mortality risk among older patients. While a combination of predictors enhanced prognostic accuracy in younger-old patients, this was not observed in the older-old group, suggesting a greater influence of frailty and comorbidities in advanced age.

References

1. 1.Chen, J., Lin, J., Wang, H., Gu, C., Lu, X., & Sun, C. (2026). Prognostic factors for mortality in age-stratified elderly sepsis patients: A retrospective cohort study based on the MIMIC-IV database. Medicine, Article 0000000000048209. https://doi.org/10.1097/MD.0000000000048209