RESUMEN
BACKGROUND: Sepsis is a critical condition with a significant risk of mortality. Advanced age is one factor in increasing mortality in intensive care. OBJECTIVES: The aim of this study is to investigate the association between mean heart rate (MHR) and 30-day mortality among older patients with sepsis in the intensive care unit (ICU). METHODS: All older patients (age 65 or older) with sepsis for first time in ICU admission in Medical Information Mart for Intensive Care-IV (MIMIC-IV) were included in this retrospective study. The effect of MHR within 24 h of ICU admission on 30-day mortality was assessed according to multivariable Cox regression models, restricted cubic splines and two-piecewise Cox regression models. RESULTS: The total number of participants was 6598 (mean heart rate, 83.8 ± 14.3 bpm). A total of 1295 (19.6%) patients died within 30 days after ICU admission. MHR within 24 h of admission was associated with 30-day mortality (J-shaped association) in older patients with sepsis in the ICU, with an inflection point at about 74 bpm and a minimal risk observed at 73 to 82 bpm of MHR. CONCLUSIONS: In this retrospective cohort study, there was a J-shaped association between MHR and 30-day mortality in older patients with sepsis admitted to the ICU and a minimal risk observed at 73 to 82 bpm of MHR. If further confirmed, this association may provide a theoretical basis for formulating the target strategy of heart rate therapy for these patients.
RESUMEN
BACKGROUND: There is limited evidence on the association between body mass index (BMI) and outcomes in older adults with sepsis. OBJECTIVES: The purpose of this study was to explore the relationship between BMI and the clinical outcome in the older adults with sepsis. METHODS: All older adults (age 65 or older) with sepsis were analyzed retrospectively in the Intensive Care Medical Information Mart (MIMIC)- IV database. The primary outcome was 30-day mortality. The relationship between BMI and 30-day mortality was estimated by multivariate logistic regression model. The interaction and stratified analysis were performed by sex, race, renal disease, congestive heart failure (CHF), diabetes, and chronic pulmonary disease. RESULTS: The total number of participants was 6604. After adjustment for potential covariates, there was a significant correlation between BMI and 30-day mortality. A 1 kg/m2 increase in BMI was associated with a 3 % decrease in 30-day mortality (adjusted HR = 0.97, 95 % CI: 0.96-0.98, P < 0.001). The correlation between BMI and 30-day mortality showed a statistically significant nonlinear association with an l-shaped curve (p = 0.001). Significant interactions were observed only for sex in the stratified analyses (P = 0.001). CONCLUSIONS: In this study, it was observed that a higher BMI is linked with better survival rates among older adults suffering from sepsis, while being underweight raises the risk of mortality. Notably, male patients with a higher BMI had a lower mortality risk compared to female patients.