• Si-Huei Lee, Tzu-Chun Hsu, Lee Meng-Tse Gabriel MG Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan., Christin Chihh-Ting Chao, Wan-Chien Lee, Chi-Cheng Lai, Chien-Chang Lee, and National Taiwan University Health Economics and Outcome Research Group.
• Department of Physical Medicine and Rehabilitation, Taipei Veteran General Hospital, Taipei, Taiwan.
• Crit. Care Med. 2018 Jun 1; 46 (6): 926-934.

ObjectiveWe aimed to compare the sepsis incidence, mortality rates, and primary sites of infection among adult, elderly, and octogenarian patients with sepsis.DesignPopulation-based cohort study.SettingThe entire health insurance claims data of Taiwan, which enrolled 99.8% of the 23 million Taiwanese population.PatientsSepsis 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.InterventionsNone.Measurements And Main ResultsFrom 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).ConclusionThe 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.

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