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Mortality in healthy elderly patients after ICU admission

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Abstract

Purpose

The aim of this study was to assess mortality in healthy elderly patients after non-elective medical ICU admission and to identify predictive factors of mortality in these patients.

Methods

Patients ≥65 years living at home and with full-autonomy (Barthel index, BI > 60), without cognitive impairment, and non-electively admitted to a medical ICU were prospectively recruited. A full comprehensive geriatric assessment was made with validated scales.

Results

A total of 230 patients were included, 110 (48%) between 65 and 74 years and 120 (52%) ≥75 years. No significant differences were observed between the two groups in premorbid functional and cognitive status, main diagnosis at ICU admission, APACHE II and SOFA scores, use of mechanical ventilation or haemodialysis or length of ICU stay. Over a mean follow-up of 522 days (range 20–1,170 days) the cumulative mortality of the whole group was 55%, being significantly higher in older subjects (62 vs. 47%; P = 0.024). On multivariate analysis, only parameters related to quality of life (QOL) and functional status were independent predictors of cumulated mortality (P < 0.01, both). Thus, in patients with EQ-5Dvas (<70) or baseline Lawton index (LI) (<5) the hazard ratio for cumulated mortality was 2.45 (95% CI: 1.15–5.25; P = 0.03) and 4.10 (95% CI: 1.53–10.99; P = 0.006), respectively, compared to those with better scores.

Conclusions

Healthy elderly non-elective medical patients admitted to the ICU have a high mortality rate related to premorbid QOL. The LI and/or EQ-5Dvas may be useful tools to identify patients with the best chance of survival.

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References

  1. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B (2007) Should elderly patients be admitted to the intensive care unit? Intensive Care Med 33:1252–1262

    Article  PubMed  Google Scholar 

  2. Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051

    Article  PubMed  Google Scholar 

  3. Boumendil A, Aegerter P, Guidet B, CUB-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53:88–93

    Article  PubMed  Google Scholar 

  4. Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C (2005) Outcomes of elderly survivors of intensive care: a review of the literature. Chest 127:1764–1774

    Article  PubMed  Google Scholar 

  5. de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E (2006) Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 32:1039–1044

    Article  PubMed  Google Scholar 

  6. Esteban A, Anzueto A, Frutos-Vivar F, Alía I, Ely EW, Brochard L, Stewart TE, Apezteguía C, Tobin MJ, Nightingale P, Matamis D, Pimentel J, Abroug F, Mechanical Ventilation International Study Group (2004) Outcome of older patients receiving mechanical ventilation. Intensive Care Med 30:639–646

    Article  PubMed  Google Scholar 

  7. Ely EW (2003) Optimizing outcomes for older patients treated in the intensive care unit. Intensive Care Med 29:2112–2115

    Article  PubMed  Google Scholar 

  8. Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395

    Article  PubMed  CAS  Google Scholar 

  9. Kaarlola A, Tallgren M, Pettilä V (2006) Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 34:2120–2126

    Article  PubMed  Google Scholar 

  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  11. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  12. Societé de Reanimation de Langue Française (1986) Utilisation de l’indice de gravité simplifié et du système oméga: Mise à jour 1986. Réanimation Soins Intensifs Médecine Urgences 2:219–221

    Google Scholar 

  13. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    PubMed  CAS  Google Scholar 

  14. Mahoney FL, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  16. Badía X, Diaz-Prieto A, Górriz MT, Herdman M, Torrado H, Farrero E, Cavaniles JM (2001) Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:1901–1907

    Article  PubMed  Google Scholar 

  17. Angus DC, Carlet J, 2002 Brussels Roundtable Participants (2003) Surviving intensive care: a report from the 2002 Brussels roundtable. Intensive Care Med 29:368–377

    PubMed  Google Scholar 

  18. Rellos K, Falagas ME, Vardakas KZ, Sermaides G, Michalopoulos A (2005) Outcome of critically ill oldest-old patients (aged 90 and older) admitted to the intensive care unit. J Am Geriatr Soc 54:110–114

    Article  Google Scholar 

  19. Demoule A, Cracco C, Lefort Y, Ray P, Derenne JP, Similovski T (2005) Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med Sci 60:129–132

    PubMed  Google Scholar 

  20. de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E (2008) Cognitive, functional and quality of life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 56:816–822

    Article  PubMed  Google Scholar 

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Acknowledgments

Financed by grants from Fondo de Investigación Sanitaria (FIS) (PI:03/0329) and Centro de Investigación Biomédica en Red (CIBER) 06/003: Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III.

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Authors and Affiliations

  1. Geriatric Unit, Department of Internal Medicine, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel, 170, 08036, Barcelona, Spain

    Emilio Sacanella, Joan Manel Pérez-Castejón, Ferran Masanés, Marga Navarro & Alfonso López-Soto

  2. Medical Intensive Care Unit, Department of Internal Medicine, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel, 170, 08036, Barcelona, Spain

    Josep Maria Nicolás & Pedro Castro

  3. Department of Internal Medicine, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain

    Emilio Sacanella

Authors
  1. Emilio Sacanella
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  2. Joan Manel Pérez-Castejón
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  3. Josep Maria Nicolás
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  4. Ferran Masanés
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  5. Marga Navarro
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  6. Pedro Castro
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  7. Alfonso López-Soto
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Corresponding author

Correspondence to Emilio Sacanella.

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Sacanella, E., Pérez-Castejón, J.M., Nicolás, J.M. et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med 35, 550–555 (2009). https://doi.org/10.1007/s00134-008-1345-8

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  • DOI: https://doi.org/10.1007/s00134-008-1345-8

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