Age-related epidemiology and outcomes of sepsis in Japanese critical care units: a nationwide administrative claims database study.

backgroundThe global rise in the elderly population presents unique challenges in intensive care, including treatment decisions and end-of-life care due to physiological, ethical, and social complexities. However, data on the very elderly remain limited, highlighting the need for real-world, large-scale studies. We aimed to characterize the age-related epidemiology and outcomes of sepsis in Japan using a nationwide administrative claims database.

methodWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database for fiscal years 2010-2019. Sepsis was defined by infection-related ICD-10 codes, blood culture testing, and administration of antimicrobials within a three-day window around admission to critical care unit. Patients were stratified into 10-year age groups, and logistic regression was used to assess the association between age and in-hospital mortality.

resultsAmong 1,880,275 critical care patients with infection-related diagnosis, 511,848 met the sepsis criteria. The median age was 76 years, and 40.0% were aged ≥ 80 years. ICU and hospital mortality increased with age, reaching 9.5% and 24.9%, respectively, in patients aged ≥ 90 years. Compared to patients aged ≤ 29 years, those aged ≥ 90 had an adjusted odds ratio of 4.75 (95% CI 4.37-5.16) for in-hospital mortality. The proportion of patients discharged home declined with age, falling to 29.4% in the ≥ 90 group. Use of organ support, including vasopressors and mechanical ventilation, was inversely related to age.

conclusionsSepsis in Japanese critical care units demonstrated substantial age-related differences in epidemiology, treatment, resource utilization, and outcomes. The disproportionately high mortality and reduced treatment intensity among the oldest patients underscore the complex clinical and ethical considerations involved in managing sepsis in aging societies. These findings emphasize the urgent need to adapt sepsis care models and critical care resource planning for the rapidly aging population in Japan and similar nations.