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.

Authors

Je Min Suh, Laurence Weinberg, Kaden Tran, Nattaya Raykateeraroj, David Pilcher, Dong-Kyu Lee

Published in

BMJ open. Volume 16. Issue 8. Pages e114774. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

To compare clinical outcomes between urinary and non-urinary tract sepsis in nonagenarians and centenarians admitted to intensive care units (ICUs).
Retrospective propensity score-matched multicentre cohort study.
Adult ICUs participating in the Australian and New Zealand Intensive Care Society Adult Patient Database across Australia and New Zealand (2010-2023).
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.
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.
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.
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.

PMID:
42547241
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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