Sepsis in Geriatric Patients

Clinical Presentation

The American College of Physicians recommends that sepsis in geriatric patients is often manifested atypically, with changes in functional status, such as altered mental status, incontinence, falls, and decreased mobility, and may occur without classical fever 1, 2, 3
The Infectious Diseases Society of America defines fever in geriatric patients as a single temperature reading ≥37.8°C (100°F) or repeated measurements of oral temperature ≥37.2°C (99°F) or rectal temperature ≥37.5°C (99.5°F) 1, 2, 3
The Society of Critical Care Medicine notes that new or worsening altered mental status is a common presentation of sepsis in geriatric patients 1, 2, 3
The American Geriatrics Society recommends that decreased mobility or falls should be considered as potential signs of sepsis in geriatric patients 1, 2
The Centers for Disease Control and Prevention state that incontinence of urine or stool may be a sign of sepsis in geriatric patients 1, 2

The Society of Critical Care Medicine notes that absence of bowel sounds (ileus) is a sign of sepsis in geriatric patients 4, 5
The American College of Chest Physicians recommends that decreased capillary refill or mottling of the skin should be considered as signs of sepsis in geriatric patients 4, 6

The American College of Cardiology defines hypotension in geriatric patients as systolic blood pressure <90 mmHg, mean arterial pressure <70 mmHg, or a decrease in systolic blood pressure >40 mmHg 4, 5, 6

The Infectious Diseases Society of America recommends that elevated C-reactive protein or procalcitonin >2 standard deviations above normal should be considered as signs of sepsis in geriatric patients 4, 5, 6
The Society of Critical Care Medicine notes that hyperlactatemia (>1 mmol/L) is a sign of sepsis in geriatric patients 4, 5
The American Society of Hematology recommends that thrombocytopenia (<100 × 10^3/μL) should be considered as a sign of sepsis in geriatric patients 4, 5

The Kidney Disease: Improving Global Outcomes (KDIGO) initiative defines acute oliguria as urine output <0.5 mL/kg/h for ≥2 hours 4, 5
The National Kidney Foundation recommends that an increase in creatinine >0.5 mg/dL (44.2 μmol/L) should be considered as a sign of acute kidney injury in geriatric patients with sepsis 4, 5
The American Thoracic Society defines arterial hypoxemia as PaO₂/FiO₂ <300 4, 5
The European Association for the Study of the Liver recommends that hyperbilirubinemia (total bilirubin >4 mg/dL or >70 μmol/L) should be considered as a sign of liver dysfunction in geriatric patients with sepsis 4, 5

The American Geriatrics Society recommends that infection is present in 77% of episodes of "functional decline" in geriatric patients 1, 2, 3