Sepsis of urinary vs non-urinary tract origin in nonagenarians and centenarians admitted to Australian and New Zealand intensive care units: a propensity-matched multicentre cohort analysis

초록

OBJECTIVES: To compare clinical outcomes between urinary and non-urinary tract sepsis in nonagenarians and centenarians admitted to intensive care units (ICUs). DESIGN: Retrospective propensity score-matched multicentre cohort study. SETTING: Adult ICUs participating in the Australian and New Zealand Intensive Care Society Adult Patient Database across Australia and New Zealand (2010-2023). PARTICIPANTS: We included all ICU admissions for sepsis in patients aged 90 years or older, classified as urinary or non-urinary tract sepsis using Acute Physiology and Chronic Health Evaluation III-J diagnostic codes. After 1:1 nearest neighbour propensity score matching, 1130 patients (565 per group) were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause mortality within 180 days and beyond 180 days. Secondary outcomes included ICU mortality, hospital mortality, ICU length of stay and hospital length of stay. RESULTS: Of 1669 patients, 573 had urinary tract sepsis and 1096 had non-urinary tract sepsis. After matching, 1130 patients were included (565 per group). In the matched cohort, non-urinary tract sepsis was associated with higher mortality within 180 days than urinary tract sepsis (HR 1.67, 95% CI 1.33 to 2.09, p<0.001), whereas mortality beyond 180 days did not differ (HR 1.03, 95% CI 0.80 to 1.34, p=0.816). ICU and hospital length of stay were similar between groups. CONCLUSIONS: Among nonagenarian and centenarian ICU patients with sepsis, infection source was an important determinant of early but not late mortality, with non-urinary tract sepsis conferring a higher risk than urinary tract sepsis. Incorporating infection source and simple physiological markers alongside illness severity scores may improve prognostication and support shared decision-making in this very old population. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

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