A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Jung, Christian; Wernly, Bernhard; Muessig, Johanna M.; Kelm, Malte; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H.; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Lichtenauer, Michael; Bruno, Raphael Romano; Marsh, Brian; Moreno, Rui; Oeyen, Sandra; Öhman, Christina Agvald; Pinto, Bernardo Bollen; Soliman, Ivo W.; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; Lange, Dylan W. de; Guidet, Bertrand; Flaatten, Hans

doi:10.1016/j.jcrc.2019.04.020

Cited by 32 publications

(26 citation statements)

References 43 publications

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“…1 ). Elective patients from VIP1 were specifically excluded as they significantly differ from acutely admitted patients in risk distribution and outcomes as previously shown 17 . The primary endpoint of this study was 30-day-mortality.…”

Section: Methodsmentioning

confidence: 99%

Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

Wernly

Bruno

Kelm

et al. 2020

Sci Rep

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Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The primary endpoint was 30-day-mortality. Baseline characteristics, data on management and geriatric scores including frailty assessed by Clinical Frailty Scale (CFS) were documented. Two propensity scores (for being male) were obtained for consecutive matching, score 1 for baseline characteristics and score 2 for baseline characteristics and ICU management. Male VIPs were younger (83 ± 5 vs. 84 ± 5; p < 0.001), less often frail (CFS > 4; 38% versus 49%; p < 0.001) but evidenced higher SOFA (7 ± 6 versus 6 ± 6 points; p < 0.001) scores. After propensity score matching, no differences in baseline characteristics could be observed. In the paired analysis, the mortality in male VIPs was higher (mean difference 3.34% 95%CI 0.92–5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03–1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04–1.27; p = 0.007) male sex was independently associated with higher odds for 30-day-mortality. Of note, male gender was not associated with ICU mortality (OR 1.08 95%CI 0.98–1.19; p = 0.14). Outcomes of elderly intensive care patients evidenced independent sex differences. Male sex was associated with adverse 30-day-mortality but not ICU-mortality. Further research to identify potential sex-specific risk factors after ICU discharge is warranted. Trial registration: NCT03134807 and NCT03370692; Registered on May 1, 2017 https://clinicaltrials.gov/ct2/show/NCT03370692.

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Section: Methodsmentioning

confidence: 99%

Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

Wernly

Bruno

Kelm

et al. 2020

Sci Rep

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“…To our knowledge, this is the first study to compare frequencies of therapeutic interventions, limitations on life-supporting treatments, risk factors for mortality, and outcomes between VIPs admitted with sepsis and those admitted for other acute reasons. In the present study, elective surgical patients were excluded because various other publications [23,[28][29][30][31][32] demonstrated that such patients have a better outcome with much lower mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Ibarz

Boumendil

Haas

et al. 2020

Ann. Intensive Care

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Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

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“…First, planned admissions have a much better prognosis, and these admissions must be analyzed separately. 36 The patients admitted after scheduled surgery are highly selected: they agree for a risky surgical procedure, anesthetists and surgeons agree to perform surgery, and very few have a limitation of lifesustaining treatment (LST). 37 It should be emphasized that the influence of frailty was more important than the age expressed per period of 5 years to predict 1-month survival.…”

Section: Outcome Survivalmentioning

confidence: 99%

Elderly Patients in the Intensive Care Unit

Beil

Guidet

2020

Semin Respir Crit Care Med

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Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a “rarity,” they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors.

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A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Cited by 32 publications

References 43 publications

Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Elderly Patients in the Intensive Care Unit

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