People over 65 are 13 times more likely to be hospitalized with sepsis than adults younger than 65, and the mortality rates for elderly patients with severe sepsis and septic shock are around 50 –60%.1- 4 These high death rates occur because the elderly often experience co-morbidities, frequent and extended hospitalizations, weakened immune systems, functional limitations, and general effects of aging like thinning skin, frailty, and a sedentary lifestyle.1
The mortality rates for elderly patients with sepsis and septic shock are around 50-60%.
Diagnosis of infection is often difficult and delayed.5 For example, the first symptom of a UTI, a leading cause of infection, is typically confusion and disorientation, making it hard for the patient to describe his or her symptoms. In addition, the presentation of symptoms can be ambiguous or atypical. Moreover, elderly patients may not exhibit fever or other clinical signs of infection or inflammation seen in younger patients, even though seniors are at higher mortality risk.
Additionally, the bladder is often colonized in many elderly people leading to false positive results of the urinalysis that show colonization and not infection. This leads to an over prescription of antibiotics in this patient population.6
The decline in immune function often observed in elderly patients7-9 can result in atypical and frequently subtle (e.g., mild fever or even apyrexia) clinical presentations of bacteremia,7,8,10-12 further increasing the risk of under diagnosis and subsequent delays in the treatment of sepsis.
Given these challenges to diagnosis, and the vulnerability of the geriatric population to infection, having a diagnostic test with high specificity and predictive value is essential. Procalcitonin (PCT) can meet this need. With PCT testing, physicians gain timely information specific to systemic bacterial infection, including its presence, course, and severity.13
One meta-analysis of four studies (760 patients, aged 65 years and older) evaluated the accuracy of procalcitonin in diagnosing systemic bacterial infections in elderly patients.11 It was found that procalcitonin is both specific and sensitive in the diagnosis of severe bacterial infection in elderly patients. As shown in randomized controlled trials, very elderly patients can benefit from the use of PCT as a means of lowering antibiotic exposure. While kidney function in many older patients may be impaired, which can affect biomarker kinetics, there is no evidence that it impacts the usefulness of PCT as a diagnostic tool. As always, test results should be interpreted in the context of clinical findings.