Association of Dementia with Mortality and Sepsis Quality Measures Among Patients Hospitalized with Sepsis
Jaclyn Talbot1, Ramin Homayouni PhD2, Paul Bozyk, MD3
1M.D. Candidate, Oakland University William Beaumont School of Medicine, Rochester, MI
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
3Department of Pulmonary and Critical Care Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection and disproportionately affects older adults.¹ ²
- Older age is an established risk factor for sepsis incidence and mortality.²
- Dementia, including Alzheimer disease, is associated with increased infection-related hospitalizations.³ ⁴
- Patients with dementia frequently present with atypical manifestations of infection, such as altered mental status or functional decline rather than classic inflammatory signs, which may delay diagnosis and treatment.³ ⁵
- Despite the high prevalence of both sepsis and dementia, limited data exist examining whether pre-existing dementia independently influences sepsis-related outcomes in hospitalized patients.
- This study investigates whether dementia is associated with differences in mortality and adherence to quality measures among patients hospitalized with sepsis.
The primary objectives of this study:
- To compare demographic characteristics and clinical outcomes among older adults hospitalized with sepsis with and without pre-existing dementia.
- To determine whether dementia is independently associated with:
- Increased 30-day mortality
- Variation in adherence to sepsis quality measures, including timely lactate measurement, fluid resuscitation, and blood culture collection
�We hypothesized that patients with dementia would be associated with:
- Higher 30-day mortality
- Greater rates of sepsis quality measure fallouts compared to patients without dementia
- Retrospective chart review of older adults hospitalized with sepsis within a large Metro Detroit health system between January 1 and December 31, 2023.
- Inclusion criteria: patients ≥65 years of age admitted with a diagnosis of sepsis.
- A total of 1,561 patients met inclusion criteria.
- Patients were stratified by documented dementia status (Alzheimer disease, non-Alzheimer dementia, and no dementia) to evaluate differences in outcomes and protocol adherence.
- Data were extracted from the electronic medical record system.
- Demographic variables collected included age, sex, and race.
- Clinical outcomes assessed were 30-day mortality and adherence to sepsis quality measures.
- Sepsis process-of-care measures included timely antibiotic administration, initial lactate measurement, fluid resuscitation, blood culture collection, and order set utilization.
- Between-group comparisons were performed to evaluate differences across dementia categories.
- Multivariable logistic regression was used to assess independent predictors of 30-day mortality, adjusting for age, gender, and race.
- Statistical significance was defined as p < 0.05.
n = 2235�Older adults ≥65 hospitalized with sepsis
n = 674�Excluded due to incomplete data
n = 1561�Final analytic cohort
�n = 312
Non-Alzheimer’s Dementia
n = 58
Alzheimer’s Disease
- A total of 1,561 patients hospitalized with sepsis were analyzed.
- Patients with Alzheimer disease were older (median 82.5 years) compared to non-Alzheimer dementia (79 years) and no dementia (69 years), while gender and racial distributions did not significantly differ across groups.
- In unadjusted analysis, mortality differed across dementia categories, with the highest rate observed in Alzheimer disease (25.86%).
- However, in multivariable logistic regression adjusting for age, gender, and race, dementia status was not independently associated with 30-day mortality; increasing age was the strongest independent predictor of death.
- Process-of-care analysis demonstrated significantly higher rates of fluid resuscitation fallout (p = 0.0085) and blood culture fallout (p = 0.0487) among patients with Alzheimer disease.
- Other sepsis quality measures did not differ significantly between groups.
- In unadjusted analysis, 30-day mortality differed across dementia categories, with the highest mortality observed among patients with Alzheimer disease.
- After adjustment for age, gender, and race, dementia status was not independently associated with 30-day mortality.
- Age was the strongest independent predictor of mortality among patients hospitalized with sepsis.
- Patients with Alzheimer disease demonstrated significantly higher rates of fluid resuscitation and blood culture process fallouts.
- These findings suggest that differences in care processes, rather than dementia diagnosis alone, may contribute to outcome disparities.
- Targeted quality improvement initiatives focusing on protocol adherence and early recognition in cognitively impaired patients may help optimize sepsis care.
- As the aging population continues to grow, improving systems-based management of older adults with sepsis remains a clinical priority.
- Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.
- Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med.2006;34(1):15-21.
- Shah FA, Pike F, Alvarez K, et al. Risk of hospitalization for infection in older adults with dementia. J Am Geriatr Soc.2016;64(3):476-481.
- Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529-1538.
- High KP, Bradley SF, Gravenstein S, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities. Clin Infect Dis. 2009;48(2):149-171.
This retrospective chart review analyzed 1,561 patients admitted with sepsis between January 1, 2023 and December 31, 2023 within a large health system in Metro Detroit. Patients were stratified into three groups: Alzheimer disease (n = 312), non-Alzheimer dementia (n = 1,249), and no dementia. Demographic variables including age, sex, and race were collected. Clinical outcomes assessed included 30-day mortality and discharge disposition. Quality measures evaluated included antibiotic timing, initial lactate measurement, fluid administration, blood culture collection, and order set utilization. Statistical analyses were performed to compare differences between groups, with significance defined as p < 0.05.