Clinically recognized sepsis in older adults admitted to medical wards: patient characteristics and hospital outcomes from the REPOSI register

Older adults admitted to internal medicine wards represent a growing population at high risk of sepsis, characterized by frailty, multimorbidity, functional impairment and reduced physiological reserve. While sepsis outcomes have been extensively studied in intensive care settings, less is known about prognostic determinants in non-ICU wards. Using data from the Italian REPOSI registry (2009-2023), we analyzed patients aged ≥65 years hospitalized in internal medicine and geriatric wards. Clinically recognized sepsis was identified through documented clinical diagnoses and corresponding ICD-9 codes. Latent Class Analysis (LCA) was used to explore multimorbidity patterns within the sepsis cohort. The primary aim was to evaluate factors associated with in-hospital mortality in older adults with sepsis. Secondary analyses compared baseline characteristics between septic and non-septic cases, assessed in-hospital mortality determinants according to sepsis onset setting (community- vs hospital-acquired), and explored factors associated with prolonged length of stay (LOS) in community-acquired sepsis. Additional descriptive analyses evaluated geographic distribution, infection sources and treatment patterns. Among 8880 patients, 504 (5.7%) had clinically recognized sepsis; more than half were hospital-acquired. In-hospital mortality was high (23.8%) and markedly higher in hospital-acquired sepsis. Two distinct multimorbidity patterns emerged: an oncologic-hepatologic profile and a diffuse chronic multimorbidity profile characterized by cardio-renal-metabolic, respiratory, and neuropsychiatric conditions. In community-acquired sepsis, the chronic multimorbidity profile was independently associated with increased mortality, whereas this association was not observed in hospital-acquired sepsis. Across the cohort, advanced age, functional dependence and hypoalbuminemia emerged as key factors independently associated with in-hospital mortality. Exploratory LOS analyses in community-acquired sepsis showed a modest association between prolonged hospitalization and higher anticholinergic burden. Additional descriptive analyses showed that lower respiratory tract infections were the most frequent source of both community- and hospital-acquired sepsis, while hospital-acquired cases showed greater heterogeneity of infectious sources and treatment patterns. In internal medicine wards, clinically recognized sepsis in older adults may reflect underlying clinical vulnerability rather than an isolated acute event. Multimorbidity patterns and geriatric-related clinical dimensions appear to influence outcomes, particularly in community-acquired sepsis. Integrating multimorbidity, nutritional and functional assessments into sepsis evaluation may improve risk stratification and support more personalized management in older hospitalized patients.

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Journal
Internal and Emergency Medicine
Published
2026-08-24
DOI
https://doi.org/10.1007/s11739-026-04501-z
Primary Topic
Sepsis Diagnosis and Treatment
Type
article
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0.00

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article

Clinically recognized sepsis in older adults admitted to medical wards: patient characteristics and hospital outcomes from the REPOSI register

Matteo Pirro, Andrea Asaro, Giulia De Nobili, Salvatore Corrao et al.
Internal and Emergency Medicine
Sepsis Diagnosis and Treatment
article

Clinically recognized sepsis in older adults admitted to medical wards: patient characteristics and hospital outcomes from the REPOSI register

Matteo Pirro, Andrea Asaro, Giulia De Nobili, Salvatore Corrao, Ilaria Martini, Marco Vincenzo Lenti, Francesco Cipollone, Salvatore Mularo, Giuseppe Natoli, Arturo Cerizza, Marco Zoli, Vincenza Beneduce, Luigi Mirarchi, Ilaria Rossi, Miriana Martelengo, Domenico Prisco, Valentina Beccati, Anna Fazzari, Costanza Caccia Dominioni, Alessia Cipollone, Giovanna Leoncini, Giacomo Bartelloni, Ilaria Lazzari, Jacopo Alberto, Chiara Giannettino, Alessia Antonella Galbussera, R. Ricciardi, Irene Mattioli, Roberto Manetti, Riccardo Alcidi, Salvatore Scibetta, Fabiana Busti, Nicola Montano, Edoardo Biancalana, Lavinia Pitotti, Marta Chiara Sircana, Federica Cacioppo, Maddalena Fabrizi, Francesca Innocenti, Alfredo Caturano, Paola Nicolini, Stefano Ciriminna, Antonello Pietrangelo, Carlotta Franchi, Federico Cattaneo, Eleonora Magnolfi, Damiano D’Ardes, Luca Pasina, Matteo Mazzetti, Sara Ratti, Ginevra Cambiè, Alessandra Marengoni, Mario Barbagallo, Mattia Brunori, Alessia Giotta, Maria Teresa Guagnano, Giacomo Emmi, Valentina Antoci, Antonio De Vincentis, Maria Laura Matacena, Alessio Novella, Elena Silvestri, Vanessa Bianconi, Roberto Pontremoli, Mauro Tettamanti, Giuseppe Orio, Giorgio Sesti, Giacomo Marchi, Antonio Di Sabatino, Rita Deda, Giovanni Serafini, Emanuela Miceli, Angelo Simili, Claudia Canizzo, Giovanna Ottavia Plano, Ilenia Imbraguglio, Sofia Contorno, REPOSI Investigators, Giacomo Corrao, Valentina Orlando, Gianni Biolo, Ligia Dominguez, Alessandra Lo Nigro, Tiziano Lucchi, Enrico Nicolis, Domenico Girelli, Miriam Zappa, Fabio Falcone, Nicola Veronese, Chiara Ronchetti, Pier Mannuccio Mannucci, Alessandro Nobili, Massimo R. Mannarino, Brenda Bongiorno, Sara Mandelli, Gabriele Ghidini, Giulia Vigani, Simona Amodeo, Graziana Lupattelli, Ilaria Ardoino
article en

Abstract

Older adults admitted to internal medicine wards represent a growing population at high risk of sepsis, characterized by frailty, multimorbidity, functional impairment and reduced physiological reserve. While sepsis outcomes have been extensively studied in intensive care settings, less is known about prognostic determinants in non-ICU wards. Using data from the Italian REPOSI registry (2009-2023), we analyzed patients aged ≥65 years hospitalized in internal medicine and geriatric wards. Clinically recognized sepsis was identified through documented clinical diagnoses and corresponding ICD-9 codes. Latent Class Analysis (LCA) was used to explore multimorbidity patterns within the sepsis cohort. The primary aim was to evaluate factors associated with in-hospital mortality in older adults with sepsis. Secondary analyses compared baseline characteristics between septic and non-septic cases, assessed in-hospital mortality determinants according to sepsis onset setting (community- vs hospital-acquired), and explored factors associated with prolonged length of stay (LOS) in community-acquired sepsis. Additional descriptive analyses evaluated geographic distribution, infection sources and treatment patterns. Among 8880 patients, 504 (5.7%) had clinically recognized sepsis; more than half were hospital-acquired. In-hospital mortality was high (23.8%) and markedly higher in hospital-acquired sepsis. Two distinct multimorbidity patterns emerged: an oncologic-hepatologic profile and a diffuse chronic multimorbidity profile characterized by cardio-renal-metabolic, respiratory, and neuropsychiatric conditions. In community-acquired sepsis, the chronic multimorbidity profile was independently associated with increased mortality, whereas this association was not observed in hospital-acquired sepsis. Across the cohort, advanced age, functional dependence and hypoalbuminemia emerged as key factors independently associated with in-hospital mortality. Exploratory LOS analyses in community-acquired sepsis showed a modest association between prolonged hospitalization and higher anticholinergic burden. Additional descriptive analyses showed that lower respiratory tract infections were the most frequent source of both community- and hospital-acquired sepsis, while hospital-acquired cases showed greater heterogeneity of infectious sources and treatment patterns. In internal medicine wards, clinically recognized sepsis in older adults may reflect underlying clinical vulnerability rather than an isolated acute event. Multimorbidity patterns and geriatric-related clinical dimensions appear to influence outcomes, particularly in community-acquired sepsis. Integrating multimorbidity, nutritional and functional assessments into sepsis evaluation may improve risk stratification and support more personalized management in older hospitalized patients.

Internal and Emergency Medicine
University of Bern (CH), University of Sassari (IT), University of Milan (IT), Mario Negri Institute for Pharmacological Research (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), San Raffaele University of Rome (IT)
Università degli Studi di Sassari
Good health and well-being
Openalex Percentile: Top 10%
Sepsis Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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