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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2006

01-07-2006 | Original

Short-term and long-term mortality in very elderly patients admitted to an intensive care unit

Authors: S. E. de Rooij, A. Govers, J. C. Korevaar, A. Abu-Hanna, M. Levi, E. de Jonge

Published in: Intensive Care Medicine | Issue 7/2006

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Abstract

Objective

To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality

Design and setting

Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital.

Patients

578 consecutive ICU patients aged 80 years or older.

Results

Demographic, physiological, and laboratory values derived from the first 24 h after ICU admission. ICU mortality of unplanned surgical (34.0%) and medical patients (37.7%) was higher than that of planned surgical patients (10.6%), as was post-ICU hospital mortality (26.5% and 29.7% vs. 4.4%). Mortality 12 months after hospital discharge, including ICU and hospital mortality, was 62.1% in unplanned surgical and 69.2% in medical patients vs. 21.6% in planned patients. Only median survival of planned surgical patients did not differ from survival in the age- and gender-matched general population. Independent risk factors for ICU mortality were lower Glasgow Coma Scale score, higher SAPS II score, the lowest urine output over 8 h, abnormal body temperature, low plasma bicarbonate levels, and higher oxygen fraction of inspired air. High urea concentrations and admission type were risk factors for hospital mortality, and high creatinine concentration was an independent risk factor for 12-month mortality.

Conclusion

Mortality in very elderly patients after unplanned surgical or medical ICU admission is higher than after planned admission. The most important factors independently associated with ICU mortality were related to the severity of illness at admission. Long-term mortality was associated with renal function.
Literature
1.
Anonymous (2000) Population projections of the United States by age, sexe and race 1999–2100. United States Census Bureau
2.
Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T Rubenfeld GD (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643PubMedCrossRef
3.
Rooij SE de, Abu-Hanna A, Levi M, de Jonge E (2005) Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 9:307–314CrossRef
4.
Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269:3119–3123PubMedCrossRef
5.
Mahul P, Perrot D, Tempelhoff G, Gaussorgues P, Jospe R, Ducreux JC, Dumont A Motin J, Auboyer C, Robert D (1991) Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med 17:7–10PubMedCrossRef
6.
Swinburne AJ, Fedullo AJ, Bixby K, Lee DK, Wahl GW (1993) Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation. Arch Intern Med 153:1657–1662PubMedCrossRef
7.
Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143PubMedCrossRef
8.
Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654PubMedCrossRef
9.
Kolh P, Kerzmann A, Lahaye L, Gerard P, Limet R (2001) Cardiac surgery in octogenarians; peri-operative outcome and long-term results. Eur Heart J 22:1235–1243PubMedCrossRef
10.
Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC Buckley MJ (1997) Cardiac operations in patients 80 years old and older. Ann Thorac Surg 4:606–614CrossRef
11.
Gehlot A, Mullany CJ, Ilstrup D, Schaff HV, Orzulak TA, Morris JJ, Daly RC (1996) Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg 111:1026–1036PubMedCrossRef
12.
Kirsch M, Guesnier L, LeBesnerais P, Hillion ML, Debauchez M, Seguin J, Loisance DY (1998) Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 66:60–67PubMedCrossRef
13.
Hamel MB, Davis RB, Teno JM, Knaus WA, Lynn J, Harrell F Jr, Galanos AN, Wu AW, Phillips RS (1999) Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 131:721–728PubMed
14.
Hamel MB, Teno JM, Goldman L, Lynn J, Davis RB, Galanos AN, Desbiens N, Connors AF Jr, Wenger N, Phillips RS (1999) Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med 130:116–125PubMed
15.
Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346 1061–1066
16.
Murphy DJ, Burrows D, Santilli S (1994) The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med 330:545–549PubMedCrossRef
17.
Wright JC, Plenderleith L, Ridley SA (2003) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642PubMedCrossRef
18.
Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859PubMedCrossRef
19.
Jonge E de, Bosman RJ, van der Voort PH, Korsten HH, Scheffer GJ, de Keizer NF (2003) Intensive care medicine in the Netherlands, 1997–2001. I. Patient population and treatment outcome. Ned Tijdschr Geneeskd 147:1013–1017PubMed
20.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef
21.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636PubMedCrossRef
22.
Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977PubMedCrossRef
23.
Lemeshow S, Teres D, Avrunin JS, Gage RW (1988) Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med 16:470–477PubMedCrossRef
24.
Le Gall JR, Klar J, Lemeshow S, for the ICU Scoring Group (1996) The Logistic Organ Dysfunction system: a new way to assess organ dysfunction in the intensive care unit. JAMA 276:802–810PubMedCrossRef
25.
Arts D, de Keizer N, Scheffer GJ, de Jonge E (2002) Quality of data collected for severity of illness scores in the Dutch National Intensive Care Evaluation (NICE) registry. Intensive Care Med 28:656–659PubMedCrossRef
26.
Bouma BJ, van den Brink RB, van der Meulen JH (1999) To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 82:143–148PubMed
27.
Johnson KS, Elbert-Avila KI, Tulsky JA (2005) The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. J Am Geriatr Soc 53:711–719PubMedCrossRef
28.
Sprung CL, Cohen SL, Sjokvist P (2003) End-of-life practices in European intensive care units: the Ethicus study. JAMA 290:790–797PubMedCrossRef
29.
Van Den Noorgate, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256CrossRef
30.
Chelluri L, Pinsky MR, Grenvik AN (1992) Outcome of intensive care of the oldest-old critically ill patients. Crit Care Med 20:757–761PubMedCrossRef
31.
Lam S, Ridley S (1999) Critically ill medical patients, their demographics and outcome. Anaesthesia 54:845–852PubMedCrossRef
32.
Bo M, Massaia M, Raspo S, Bosco F, Cena P, Molaschi M, Fabris F (2003) Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc 51:529–533PubMedCrossRef
33.
Chelluri L, Im KA, Belle SH, Schulz R, Rotondi AJ, Donahoe MP, Sirio CA, Mendelsohn AB, Pinsky MR (2004) Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 32:61–69PubMedCrossRef
34.
Ridley S, Jackson R, Findlay J, Wallace P (1990) Long-term survival after intensive care. BMJ 301:1127–1130PubMedCrossRef
Metadata
Title
Short-term and long-term mortality in very elderly patients admitted to an intensive care unit
Authors
S. E. de Rooij
A. Govers
J. C. Korevaar
A. Abu-Hanna
M. Levi
E. de Jonge
Publication date
01-07-2006
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0171-0

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