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Research ArticleOriginal Research

Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo del-Sorbo, Maria del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban and Christian Jung
Respiratory Care May 2021, 66 (5) 814-821; DOI: https://doi.org/10.4187/respcare.08547
Bernhard Wernly
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Raphael Romano Bruno
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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Fernando Frutos-Vivar
Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain.
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Oscar Peñuelas
Medizinische Hochschule, Hannover, Germany.
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Richard Rezar
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Konstantinos Raymondos
Medizinische Hochschule, Hannover, Germany.
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Alfonso Muriel
Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain.
Unidad de Bioestadística, Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias & Centro de Investigación en Red de Opidemiología y Salud Pública, Madrid, Spain.
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Bin Du
Peking Union Medical College Hospital, Beijing, People's Republic of China.
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Arnaud W Thille
University Hospital of Poitiers, Poitiers, France.
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Fernando Ríos
Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.
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Marco González
Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia.
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Lorenzo del-Sorbo
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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Maria del Carmen Marín
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional 1 de Octubre, México City, México.
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Bruno Valle Pinheiro
Pulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
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Marco Antonio Soares
Hospital Universitario Sao Jose, Belo Horizonte, Brazil.
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Nicolas Nin
Hospital Universitario de Montevideo, Montevideo, Uruguay.
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Salvatore M Maggiore
Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy.
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Andrew Bersten
Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia.
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Malte Kelm
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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Pravin Amin
Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Nahit Cakar
Istanbul Faculty of Medicine, Istanbul, Turkey.
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Gee Young Suh
Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.
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Fekri Abroug
Hospital Fattouma Bourguina, Monastir, Tunisia.
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Manuel Jibaja
Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
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Dimitros Matamis
Papageorgiou Hospital, Thessaloniki, Greece.
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Amine Ali Zeggwagh
Centre Hospitalier Universitarie, Ibn Sina - Mohammed V University, Rabat, Morocco.
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Yuda Sutherasan
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Bertrand Guidet
Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Sorbonne Universités, Paris, France.
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Dylan W De Lange
Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
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Michael Beil
Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel.
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Sigal Svri
Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel.
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Vernon van Heerden
Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel.
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Hans Flaatten
Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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Antonio Anzueto
South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.
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Venet Osmani
Fondazione Bruno Kessler Research Institute, Trento, Italy.
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Andrés Esteban
Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain.
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Christian Jung
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation.

METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65–79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis.

RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16–1.49], P < .001).

CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.)

  • critically ill
  • elderly subjects
  • ICU
  • risk stratification
  • risk scores
  • mechanical ventilation

Footnotes

  • Correspondence: Christian Jung MD PhD, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany. E-mail: christian.jung{at}med.uni-duesseldorf.de
  • Drs Wernly and Bruno are co-first authors.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (5)
Respiratory Care
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1 May 2021
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Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients
Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo del-Sorbo, Maria del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung
Respiratory Care May 2021, 66 (5) 814-821; DOI: 10.4187/respcare.08547

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Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients
Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo del-Sorbo, Maria del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung
Respiratory Care May 2021, 66 (5) 814-821; DOI: 10.4187/respcare.08547
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Keywords

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  • risk stratification
  • risk scores
  • mechanical ventilation

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