Acute respiratory infection hospitalized in intensive care unit: long-term outcome in Elderly

Abstract

Background The consequences of the ageing population concerning ICU-hospitalization need to be adequately described, especially acute respiratory infections (ARI) strongly associated with Elderly. The study aimed to assess the long-term outcomes of ARI surviving ICU hospitalization in patients over 80 yo. Methods A retrospective multicentre cohort study was performed, based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with ARI in ICU were selected according to specific ICD-10 diagnosis codes recorded and matched with a control population (patient undergoing a cataract surgery), using a propensity score (matching algorithm 1:1 ratio, caliper 0.002) with the matching variables (age, sex, frailty score, chronic heart disease, chronic pulmonary disease and cancer). Analyzes of this matched population were performed to determine their 2-year in-hospital mortality, healthcare utilization and evolution of the frailty score during the 2-year period before/after the inclusion stay. Results A total of 1,658 hospital stays for ARI after 80 yo were identified, with 438 dead (26%) during the initial stay. After matching with the cataract population, 988 patients were selected in each group without difference in the propensity score. ARI lead to an important increase of healthcare use during the 2 years after discharge. The patients that were discharged from hospital after ARI requiring ICU, had a 23-fold increase of death at 90 days and 4-fold at 2 years and the evolution of the frailty score was 1.6 fold higher than the cataract population. Conclusions Elderly patients with severe ARI survived from their ICU stay in 75%, but have a major risk of death in the following months, and an important increase in healthcare consumption. Our findings provide data for more informed goals-of-care discussions and may help target post-ICU discharge services for these high-risk groups. Key messages Elderly patients with severe acute respiratory infection survived ICU in 75%, but had a major risk of death in the following months, added to a substantial increase in healthcare consumption. These findings provide data for more informed goals-of-care discussions and may help target interventions for these high-risk groups.