The Association of Macrophage Activation-Like Syndrome with Mortality in Elderly Patients with Sepsis

Abstract

Introduction: Among the geriatric population, when compared to younger individuals, mortality is high. Macrophage activation-like syndrome (MALS) has been reported to be an independent immunological entity associated with mortality among sepsis patients in adults which represents the increased inflammation state. This study aimed to investigate the frequency of MALS in elderly sepsis patients and its association with intensive care unit (ICU) mortality. Materials and Methods: This retrospective study included patients aged 65 years or older with sepsis between January 2013 and January 2022 in the ICU of the Internal Medicine Department of Ege University Hospital. MALS was diagnosed with a hemophagocytic syndrome score (H-score) of ≥151 and/or co-presence of hepatobiliary dysfunction (HBD) and disseminated intravascular coagulation (DIC). Clinical, demographic, and laboratory results were retrieved from the medical records. Factors affecting ICU mortality were investigated with binary logistic regression analysis. Results: In our study of 194 patients, mortality was 46.4% and MALS frequency was 23.7%. Among non-survivors, MALS frequency was significantly higher than survivors; 32.2% and 16.3%, p= 0.010. The median H-score was 117 in non-survivors and 78.5 in survivors, p= 0.002. ICU mortality of elderly sepsis patients increased by approximately 25 times when MALS was present. Age was not identified as a risk factor for ICU mortality. Conclusion: Among elderly sepsis patients, the frequency of MALS was found to be remarkably high in our single-center study. MALS may be one of the reasons for increased mortality in elderly sepsis patients.

Keywords

• sepsis
• macrophages
• mortality
• elderly
• critical care