Sepsis in Hospitalized Elderly: Source-Specific Mortality Patterns, Predictors, and Clinical Outcomes

Abstract

Introduction: Sepsis is still the primary cause of illness and mortality among the elderly globally, with particularly high fatality rates in low- and middle-income nations. Age-related physiological decline, multimorbidity, and polypharmacy all increase risk and impair outcomes. The purpose of this study was to look at the clinical profile, infection sources, and predictors of death in elderly sepsis patients admitted to a tertiary care hospital in northern India.

Methods: A retrospective observational study was undertaken at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, with elderly patients (≥60 years) hospitalized between January 2023 and December 2024. Demographic, clinical, and laboratory data were evaluated. Independent predictors of mortality were found using multivariable logistic regression, and model performance was assessed using the area under the receiver operating characteristic (ROC) curve.

Results: Among 16,757 admissions, overall in-hospital mortality was 15.8%, with sepsis accounting for 32.4% of deaths. Respiratory infections were the most common source (56.8%), followed by urinary tract infections (14.8%). Independent predictors of mortality included hypoalbuminemia (OR 3.2, 95% CI 2.1–4.9), elevated lactate (OR 2.9, 95% CI 1.8–4.6), polypharmacy (OR 2.8, 95% CI 1.9–4.1), acute kidney injury (OR 2.5, 95% CI 1.7–3.6), and hyponatremia (OR 2.1, 95% CI 1.4–3.2). The final model showed excellent discrimination (AUC =

0.82, 95% CI 0.78–0.86).

Conclusion: Sepsis is the most common cause of death in older individuals, primarily due to respiratory infections. Hypoalbuminemia, increased lactate levels, polypharmacy, acute renal damage, and hyponatremia all predict death. The prediction model demonstrated excellent discrimination (AUC = 0.82), highlighting the importance of early detection and targeted management to enhance outcomes in this vulnerable group.