What is The Effectiveness of Early Goal-Directed Therapy Compared to Standard Care on Mortality Outcomes in Geriatric Patients (Age ≥ 65) with Sepsis? : A Systematic Review
Keywords:
Sepsis, Early Goal-Directed Therapy, Geriatrics, Mortality, Systematic ReviewAbstract
Introduction: Sepsis is a leading cause of mortality, particularly in geriatric patients (≥65 years). Early Goal-Directed Therapy (EGDT) was widely adopted after initial studies showed mortality benefits, but landmark trials later questioned its efficacy. A critical evidence gap exists regarding EGDT’s effectiveness in the elderly, who are underrepresented and under-analyzed.
Methods: This systematic review synthesized evidence from 80 studies (RCTs, etc) comparing EGDT to standard care in sepsis. We focused on overall mortality outcomes, subgroup analyses by age, and the specific representation of geriatric patients.
Results: Three major RCTs (ProCESS, ARISE, ProMISe, n≈4,200) found no mortality benefit of EGDT over usual care (e.g., 90-day mortality: EGDT 24.9% vs. usual care 25.4%; p=0.90). However, early meta-analyses (pre-2014) showed EGDT reduced mortality (RR 0.83, 95% CI 0.71-0.96). Only one study exclusively enrolled patients ≥65 years (Endo et al., 2025), finding that aggressive hemodynamic targets increased 90-day mortality (39.3% vs. 28.6%; p=0.012). No studies provided age-stratified analyses or tested for age-treatment interactions.
Discussion: The apparent effectiveness of EGDT is highly context-dependent. Its benefit disappears when compared to contemporaneous usual care that has incorporated EGDT’s core principles (early fluids, vasopressors, antibiotics). For geriatric patients, there is a complete absence of direct evidence comparing EGDT to standard care. The single study in the elderly suggests potential harm from aggressive targets, highlighting a critical knowledge gap.
Conclusion: EGDT offers no mortality benefit over modern standard care in general adult sepsis populations. Its historical benefit likely reflects the adoption of its components into routine practice. The effectiveness and safety of EGDT in geriatric patients remain unknown, representing a major research priority.
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