Distinct determinants of long-term and short-term survival in critical illness

Garland, Allan; Olafson, Kendiss; Ramsey, Clare D.; Yogendran, Marina; Fransoo, Randy

doi:10.1007/s00134-014-3348-y

Cited by 76 publications

(79 citation statements)

References 35 publications

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“…continued from Table 3 In some situations, surgical intervention is necessary in the case of fractures among the elderly, and the intensive therapy unit is the site of immediate post-surgical recovery for the most severe cases, which in the present study were considered as hospitalizations for surgical reasons. However, hospitalizations for clinical reasons appeared as a risk in the survival table and in the multiple Cox model, a finding also obtained by other studies 12,14,18 . It is therefore assumed that the elective and controlled nature of non-emergency surgical procedures guarantee lower mortality than clinical events that usually affect the elderly in an acute and unexpected way.…”

Section: Resultssupporting

confidence: 83%

“…This period of time is justified by the fact that international studies of survival usually consider two groups of predictors of mortality: impacting factors that have an effect in up to 30 days, known as short-terms; and long-terms, which are variables that impact survival after 30 days from the date of admission. It was also observed in other studies that the average length of hospitalization of the elderly in ICUs, including standard deviations, is around 20 days [11][12][13] . Remaining faithful to these assumptions is important for discussion and comparison between different studies.…”

Section: Methodssupporting

confidence: 64%

“…In studies with a followup period of more than 30 days, comorbidities are associated with a worse survival prognosis, which is consistent with the results presented here. However, the variable sepsis is equally significant in survival studies with both short and long follow-up periods, including those of up to five years, which highlights the impact of this variable on the mortality of elderly patients in ICUs [12][13][14] .…”

Section: Resultsmentioning

confidence: 99%

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Survival analysis of elderly patients in Intensive Care Units

Bonfada

Santos

Lima

et al. 2017

Rev. bras. geriatr. gerontol.

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Objective: Conduct a survival analysis of elderly patients hospitalized in an intensive care unit (ICU), identifying the predictors of mortality among this age group. Methods: A retrospective cohort study was performed with data from the medical records of 457 elderly patients hospitalized in an ICU located in the city of Natal in Brazil. Survival functions were estimated using the Kaplan-Meier estimator, and the Log-rank test was used for comparisons. In addition, a multiple Cox proportional hazards model was constructed to identify the independent effects of the predictors of survival. Results: It was found that the survival of elderly ICU patients declined due to factors such as increased hospitalization time, advancing years, unmarried (including common-lawmarriage) status, the presence of shock, pneumonia, septicaemia, fractures, a reduced state of consciousness, hospitalization for clinical reasons, being bedridden prior to hospitalization, fever, bradycardia, hypotension, cardiac arrest and the need for mechanical ventilation. The multiple Cox proportional hazards model revealed that variables such as shock, longevity, bradycardia, fractures, fever, hospitalization in the public healthcare system and admission for clinical reasons remained significant as predictors of reduced survival in intensive care units. Conclusions: The survival rates of elderly persons in an ICU in the city of Natal in Brazil were affected by demographic and clinical predictors, and those related to the type of hospitalization and the health care network. This shows that any initiative aimed at increasing the survival of elderly ICU patients must look at individual and social issues and factors related to the health care network.

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Section: Resultssupporting

confidence: 83%

Section: Methodssupporting

confidence: 64%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Survival analysis of elderly patients in Intensive Care Units

Bonfada

Santos

Lima

et al. 2017

Rev. bras. geriatr. gerontol.

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“…6 Some argue that this late mortality is simply a reflection of the underlying comorbidity burden of patients who develop sepsis, whereas others argue it is the result of sepsis itself. [7][8][9][10] Previous studies have provided evidence on both sides of the debate. Several studies explicitly assert that late mortality after critical illness is largely because of pre-existing comorbid disease.…”

Section: Introductionmentioning

confidence: 99%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

265

214

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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“…The observational cohort study published by Garland et al (1) looked to identify which determinants were responsible for short-term and long-term survival in adult patients admitted to intensive care units. They found that with respect to long term mortality i.e., post 90-day mortality the most important determinants were age and co-morbidity, characteristics of the acute illness came a distant third (one major limitation of this study however is that it assessed unselected patients admitted to intensive care units, without specific focus on sepsis).…”

mentioning

confidence: 99%