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Short-term and long-term mortality in very elderly patients admitted to an intensive care unit

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Abstract

Objective

To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality

Design and setting

Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital.

Patients

578 consecutive ICU patients aged 80 years or older.

Results

Demographic, physiological, and laboratory values derived from the first 24 h after ICU admission. ICU mortality of unplanned surgical (34.0%) and medical patients (37.7%) was higher than that of planned surgical patients (10.6%), as was post-ICU hospital mortality (26.5% and 29.7% vs. 4.4%). Mortality 12 months after hospital discharge, including ICU and hospital mortality, was 62.1% in unplanned surgical and 69.2% in medical patients vs. 21.6% in planned patients. Only median survival of planned surgical patients did not differ from survival in the age- and gender-matched general population. Independent risk factors for ICU mortality were lower Glasgow Coma Scale score, higher SAPS II score, the lowest urine output over 8 h, abnormal body temperature, low plasma bicarbonate levels, and higher oxygen fraction of inspired air. High urea concentrations and admission type were risk factors for hospital mortality, and high creatinine concentration was an independent risk factor for 12-month mortality.

Conclusion

Mortality in very elderly patients after unplanned surgical or medical ICU admission is higher than after planned admission. The most important factors independently associated with ICU mortality were related to the severity of illness at admission. Long-term mortality was associated with renal function.

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References

  1. Anonymous (2000) Population projections of the United States by age, sexe and race 1999–2100. United States Census Bureau

  2. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T Rubenfeld GD (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643

    Article  PubMed  Google Scholar 

  3. Rooij SE de, Abu-Hanna A, Levi M, de Jonge E (2005) Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 9:307–314

    Article  Google Scholar 

  4. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269:3119–3123

    Article  PubMed  CAS  Google Scholar 

  5. Mahul P, Perrot D, Tempelhoff G, Gaussorgues P, Jospe R, Ducreux JC, Dumont A Motin J, Auboyer C, Robert D (1991) Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med 17:7–10

    Article  PubMed  CAS  Google Scholar 

  6. Swinburne AJ, Fedullo AJ, Bixby K, Lee DK, Wahl GW (1993) Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation. Arch Intern Med 153:1657–1662

    Article  PubMed  CAS  Google Scholar 

  7. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143

    Article  PubMed  Google Scholar 

  8. Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654

    Article  PubMed  Google Scholar 

  9. Kolh P, Kerzmann A, Lahaye L, Gerard P, Limet R (2001) Cardiac surgery in octogenarians; peri-operative outcome and long-term results. Eur Heart J 22:1235–1243

    Article  PubMed  CAS  Google Scholar 

  10. Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC Buckley MJ (1997) Cardiac operations in patients 80 years old and older. Ann Thorac Surg 4:606–614

    Article  Google Scholar 

  11. Gehlot A, Mullany CJ, Ilstrup D, Schaff HV, Orzulak TA, Morris JJ, Daly RC (1996) Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg 111:1026–1036

    Article  PubMed  CAS  Google Scholar 

  12. Kirsch M, Guesnier L, LeBesnerais P, Hillion ML, Debauchez M, Seguin J, Loisance DY (1998) Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 66:60–67

    Article  PubMed  CAS  Google Scholar 

  13. Hamel MB, Davis RB, Teno JM, Knaus WA, Lynn J, Harrell F Jr, Galanos AN, Wu AW, Phillips RS (1999) Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 131:721–728

    PubMed  CAS  Google Scholar 

  14. Hamel MB, Teno JM, Goldman L, Lynn J, Davis RB, Galanos AN, Desbiens N, Connors AF Jr, Wenger N, Phillips RS (1999) Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med 130:116–125

    PubMed  CAS  Google Scholar 

  15. Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346 1061–1066

    Google Scholar 

  16. Murphy DJ, Burrows D, Santilli S (1994) The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med 330:545–549

    Article  PubMed  CAS  Google Scholar 

  17. Wright JC, Plenderleith L, Ridley SA (2003) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642

    Article  PubMed  CAS  Google Scholar 

  18. Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859

    Article  PubMed  CAS  Google Scholar 

  19. Jonge E de, Bosman RJ, van der Voort PH, Korsten HH, Scheffer GJ, de Keizer NF (2003) Intensive care medicine in the Netherlands, 1997–2001. I. Patient population and treatment outcome. Ned Tijdschr Geneeskd 147:1013–1017

    PubMed  Google Scholar 

  20. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  21. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    Article  PubMed  CAS  Google Scholar 

  22. Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977

    Article  PubMed  Google Scholar 

  23. Lemeshow S, Teres D, Avrunin JS, Gage RW (1988) Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med 16:470–477

    Article  PubMed  CAS  Google Scholar 

  24. Le Gall JR, Klar J, Lemeshow S, for the ICU Scoring Group (1996) The Logistic Organ Dysfunction system: a new way to assess organ dysfunction in the intensive care unit. JAMA 276:802–810

    Article  PubMed  Google Scholar 

  25. Arts D, de Keizer N, Scheffer GJ, de Jonge E (2002) Quality of data collected for severity of illness scores in the Dutch National Intensive Care Evaluation (NICE) registry. Intensive Care Med 28:656–659

    Article  PubMed  Google Scholar 

  26. Bouma BJ, van den Brink RB, van der Meulen JH (1999) To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 82:143–148

    PubMed  CAS  Google Scholar 

  27. Johnson KS, Elbert-Avila KI, Tulsky JA (2005) The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. J Am Geriatr Soc 53:711–719

    Article  PubMed  Google Scholar 

  28. Sprung CL, Cohen SL, Sjokvist P (2003) End-of-life practices in European intensive care units: the Ethicus study. JAMA 290:790–797

    Article  PubMed  Google Scholar 

  29. Van Den Noorgate, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256

    Article  Google Scholar 

  30. Chelluri L, Pinsky MR, Grenvik AN (1992) Outcome of intensive care of the oldest-old critically ill patients. Crit Care Med 20:757–761

    Article  PubMed  CAS  Google Scholar 

  31. Lam S, Ridley S (1999) Critically ill medical patients, their demographics and outcome. Anaesthesia 54:845–852

    Article  PubMed  CAS  Google Scholar 

  32. Bo M, Massaia M, Raspo S, Bosco F, Cena P, Molaschi M, Fabris F (2003) Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc 51:529–533

    Article  PubMed  Google Scholar 

  33. Chelluri L, Im KA, Belle SH, Schulz R, Rotondi AJ, Donahoe MP, Sirio CA, Mendelsohn AB, Pinsky MR (2004) Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 32:61–69

    Article  PubMed  Google Scholar 

  34. Ridley S, Jackson R, Findlay J, Wallace P (1990) Long-term survival after intensive care. BMJ 301:1127–1130

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Academic Medical Center, 22700, 1100 DE, Amsterdam, The Netherlands

    S. E. de Rooij, A. Govers & M. Levi

  2. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, 22700, 1100 DE, Amsterdam, The Netherlands

    J. C. Korevaar

  3. Department of Medical Informatics, Academic Medical Center, 22700, 1100 DE, Amsterdam, The Netherlands

    A. Abu-Hanna

  4. Department of Intensive Care, Academic Medical Center, 22700, 1100 DE, Amsterdam, The Netherlands

    E. de Jonge

Authors
  1. S. E. de Rooij
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  2. A. Govers
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  3. J. C. Korevaar
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  4. A. Abu-Hanna
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  5. M. Levi
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  6. E. de Jonge
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Corresponding author

Correspondence to S. E. de Rooij.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0172-z

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de Rooij, S.E., Govers, A., Korevaar, J.C. et al. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 32, 1039–1044 (2006). https://doi.org/10.1007/s00134-006-0171-0

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  • DOI: https://doi.org/10.1007/s00134-006-0171-0

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