Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background </jats:bold>Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.<jats:bold>Methods </jats:bold>We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score<jats:bold> </jats:bold>matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.<jats:bold>Results </jats:bold>1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.<jats:bold>Conclusions </jats:bold>We observed a substantially increased rate of death in the years following ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.<jats:bold>Funding:</jats:bold> None</jats:p>

Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK

“…The benefit of ICU admission for older frail patients remains uncertain, as rates of mortality and long-term functional impairment in survivors are high in this population. 35 Critical care interventions might not be associated with improved outcomes in this group. In a previous study, protocolised ICU referral in patients aged 75 years and older led to significantly higher ICU admission rates but had no significant effect on mortality, functional status, or health-related quality of life.…”

Long-term mortality of elderly patients after intensive care unit admission for COVID-19

“…Community-acquired pneumonia in critically ill elderly is associated with higher long-term mortality: patients over 80 years old (y.o.) hospitalised in the intensive care unit (ICU) for respiratory infection had a tenfold increased risk of death 6 months post-hospitalisation [ 1 ]. Noteworthy, the number of elderly patients admitted to an ICU steadily increased, likely reflecting the aging population [ 2 ].…”