Determinants of hospital and one-year mortality among older patients admitted to intensive care units: results from the multicentric SENIOREA cohort.

Critical care outcomes Mechanical ventilation Older adults Outcome assessment (health care)

Journal

Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873

Informations de publication

Date de publication:
17 Feb 2021
Historique:
received: 09 10 2020
accepted: 07 01 2021
entrez: 17 2 2021
pubmed: 18 2 2021
medline: 18 2 2021
Statut: epublish

Résumé

Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients' place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171.

Sections du résumé

BACKGROUND BACKGROUND
Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population.
METHODS METHODS
We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit.
RESULTS RESULTS
501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients' place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors.
CONCLUSIONS CONCLUSIONS
The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171.

Identifiants

DOI: 10.1186/s13613-021-00804-w PMID: 33595733 PMC: PMC7889762
pubmed: 33595733
doi: 10.1186/s13613-021-00804-w
pii: 10.1186/s13613-021-00804-w
pmc: PMC7889762
doi:

Banques de données

ClinicalTrials.gov
['NCT01679171']

Types de publication

Journal Article

Langues

eng

Pagination

35

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Auteurs

Julien Demiselle (J)

Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France.

Guillaume Duval (G)

Department of Geriatric Medicine, Angers University Hospital, 4 rue du Larrey, 49933 cedex 9, Angers, France.
Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, 4 rue du Larrey, 49933 cedex 9, Angers, France.

Jean-François Hamel (JF)

Maison de la Recherche, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France.

Anne Renault (A)

Service de Réanimation Médicale, Centre Hospitalier Universitaire, Boulevard Tanguy Prigent, 29609, Brest, France.

Laetitia Bodet-Contentin (L)

Hôpital Bretonneau, Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire de Tours, 2 Bis Boulevard Tonnellé, 37044, Tours Cedex 09, France.

Laurent Martin-Lefèvre (L)

Service de Réanimation Polyvalente, Centre Hospitalier Départemental Vendée-Hôpital de La-Roche-sur-Yon, Les Oudairies, 85925, La-Roche-sur-Yon Cedex 09, France.

Dominique Vivier (D)

Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 09, France.

Daniel Villers (D)

Hôtel-Dieu, Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 30 bd Jean Monnet, 44093, Nantes, France.

Montaine Lefèvre (M)

Centre Hospitalier Des Pays de Morlaix, Service de Réanimation Polyvalente, 15, Rue de Kersaint Gilly, BP 97237, 29672, Morlaix Cedex, France.

René Robert (R)

CHU de Poitiers, Service de Réanimation Médicale, 2, Rue de la Milétrie, CS 90577, 86021, Poitiers Cedex, France.

Philippe Markowicz (P)

Centre Hospitalier de Cholet, Service de Réanimation Polyvalente, 1 Rue de Marengo, BP 507, 49325, Cholet Cedex, France.

Sylvain Lavoué (S)

Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Unité de Réanimation Médicale, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.

Anne Courte (A)

Centre Hospitalier de Saint Brieuc, Service de Réanimation Polyvalente, 10, Rue Marcel Proust, BP 2367, 22027, Saint Brieux Cedex 01, France.

Eddy Lebas (E)

Centre Hospitalier Bretagne Atlantique, 20 Boulevard Général Maurice Guillaudot, BP 70555, 56017, Vannes Cedex, France.

Stéphanie Chevalier (S)

Centre Hospitalier de Saint Malo, Service de Réanimation Polyvalente, 1, Rue de la Marne, 35403, Saint Malo Cedex, France.

Cédric Annweiler (C)

Department of Geriatric Medicine, Angers University Hospital, 4 rue du Larrey, 49933 cedex 9, Angers, France.
Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, 4 rue du Larrey, 49933 cedex 9, Angers, France.
Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.

Nicolas Lerolle (N)

Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France. nicolas.lerolle@univ-angers.fr.

Classifications MeSH