Critically ill patient mortality by age: long-term follow-up (CIMbA-LT)

Abstract

Background The past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied. Methods The Critically Ill patients’ mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group. Results We included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63–0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98–1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8–6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1–39.6) vs. 2.4; (95% CI 2.2–2.7) for older patients]. Conclusions Critically ill patients’ mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.

Non-linear association between aspartate aminotransferase to alanine aminotransferase ratio and mortality in critically ill older patients: A retrospective cohort study

“…Because of the newly accessible sophisticated life support, an increasing number of older and more severely ill patients are receiving treatment in this environment. However, such patients are associated with elevated all-cause mortality rates [ 26 ]. In our study, the in-hospital mortality rate for critically ill older patients was found to be 18.8%, and this mortality was similar to other investigations reported.…”

Circadian Influences on Myocardial Ischemia-Reperfusion Injury and Heart Failure

“…The rising burden of critical illness around the world and the demand for more ICU beds underscore the urgency for research aiming to improve outcomes for critically ill patients. 180 With mortality rates around 16% in the critically ill, 181 addressing disruptions in circadian rhythms-crucial to physiological homeostasis-is imperative. The ICU environment and postoperative care often disturb these rhythms due to the absence of natural cues such as light, regular meals, and physical activity.…”

Economic Burden of ICU-Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis

“…This increase in hospitalization days implies an increase in hospitalization costs [ 22 , 30 , 47 ]. Furthermore, the one study from Portugal included in our review reported a median ICU LOS value of nine days (7.00 - 12.00), while another study examining the period from January 2015 to June 2019 in Portugal reported a median ICU LOS value of four days (2.00 - 9.00) [ 37 , 48 ]. The study from India included in our analysis reported a mean ICU LOS value of nine days (IQR: 5-13).…”