Background: Crystalloid bolus administration remains a cornerstone of sepsis management. Studies indicate that geriatric patients with sepsis benefit from guideline-recommended bundles. The effect of fluid timeliness on patient-centered outcomes in geriatric patients with sepsis is unknown. We conducted a retrospective cohort study to assess association between time-to-crystalloid and composite mortality and discharge to hospice. Hospital length of stay (LOS), ICU LOS, ICU admission and intubation rate were investigated secondarily. These outcomes were compared in prespecified prompt (< 60 minutes), early (60-180 minutes), and late ( >180 minutes) resuscitation groups, and within the cohort as a whole.
Results: 225 patients were included in this study. 46.2% received crystalloid before 60 minutes, while 40.9% and 12.9% of patients were resuscitated within 60-180 minutes and greater than 180 minutes, respectively. Baseline characteristics in all three groups were similar. There was no difference in composite in-hospital mortality or hospice discharge [27 (26.2%) vs. 24 (26.4%) vs. 10 (34.5%); p=0.653] between the three groups. The late crystalloid administration group had statistically significant longer ICU LOS [2.35 (3.99) vs. 3.82 (6.42) vs 6.14 (7.31); p=0.014] and increased intubation rate [6 (5.8) vs. 6 (6.5) vs. 6(20.7); p=0.026]. Regression analyses indicated that time-to-crystalloid directly correlated with hospital LOS, ICU LOS and intubation rate.
Conclusions: In this hypothesis-generating cohort study of geriatric patients with sepsis, there was no association between time-to-crystalloid and composite in-hospital mortality or hospice discharge.
Sepsis, Hemodynamics, Geriatric, Elderly, Crystalloid, Bolus, Fluid, Resuscitation, Timeliness