ปัจจัยทำนายการเสียชีวิตภายใน 28 วันในผู้ป่วยสูงอายุที่สงสัยติดเชื้อในแผนกฉุกเฉิน  โรงพยาบาลสรรพสิทธิประสงค์ อุบลราชธานี: Predictive Factors for 28-Day Mortality in Elderly Patients with Suspected Infection in the Emergency Department, Sappasithiprasong Hospital, Ubon Ratchathani

Tanitawadee Chuechot

Authors

Tanitawadee Chuechot -

Keywords:

Keywords: elderly patients, sepsis, mortality predictors, emergency department, MOD score

Abstract

Abstract

Background: Sepsis in elderly patients is a major public health problem with high mortality. Early identification of patients at risk of death at the emergency department triage may improve clinical

out comes through timely intervention.
Objective: To identify predictive factors for 28-day mortality, describe the epidemiology, and compare clinical characteristics between elderly patients with suspected sepsis who died and survived within 28 days at the Emergency Department of Sappasithiprasong Hospital, Ubon Ratchathani.

Methods: A retrospective analytical study was conducted in patients aged ≥ 60 years with suspected sepsis according to the ED sepsis protocol at Sappasithiprasong Hospital from October 1, 2022 to September 30, 2025. Data were extracted from electronic medical records. Univariable and multivariable Cox proportional hazards regression were used to identify independent predictors of 28-day mortality, reported as hazard ratios (HR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05.

Results: A total of 396 patients were enrolled; mean age 74.4 ± 9.9 years, 55.3% female. The 28-day mortality was 30.3% (n = 120). The most common infection source was respiratory (53.8%) and 23.0% were diagnosed with septic shock. Significant differences between the death and survival groups were observed in vital signs, consciousness level, qSOFA score, NEWS score, functional status, and laboratory findings. Multivariable Cox regression using the three MOD score variables identified two independent predictors of 28-day mortality: Dependent status (D; HR 2.51, 95% CI 1.60-3.93, p < 0.001) and Oxygen saturation ≤ 93% (O; HR 1.83, 95% CI 1.26-2.65, p = 0.001), while Malignancy (M; HR 1.23, 95% CI 0.74-2.05, p = 0.430) showed a trend but did not reach statistical significance. The MOD model demonstrated a C-statistic of 0.711.

Conclusion: The 28-day mortality rate in elderly patients with suspected sepsis at the ED of Sappasithiprasong Hospital was 30.3%. The MOD score, particularly Dependent status and SpO₂ ≤ 93%, were independent predictors of 28-day mortality that can be rapidly assessed at triage without laboratory results, making them suitable for early risk stratification in tertiary care emergency settings. External validation in other populations is warranted.

Keywords: elderly patients, sepsis, mortality predictors, emergency department, MOD score

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