Management and outcomes in critically ill nonagenarian versus octogenarian patients.
Frailty
Intensive care medicine
Nonagenarians
Octogenarians
Outcome
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
19 10 2021
19 10 2021
Historique:
received:
13
01
2021
accepted:
17
09
2021
entrez:
20
10
2021
pubmed:
21
10
2021
medline:
28
10
2021
Statut:
epublish
Résumé
Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. NCT03134807 and NCT03370692 .
Sections du résumé
BACKGROUND
Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients.
METHODS
We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians.
RESULTS
The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)).
CONCLUSION
After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.
TRIAL REGISTRATION
NCT03134807 and NCT03370692 .
Identifiants
pubmed: 34666709
doi: 10.1186/s12877-021-02476-4
pii: 10.1186/s12877-021-02476-4
pmc: PMC8524896
doi:
Banques de données
ClinicalTrials.gov
['NCT03370692', 'NCT03134807']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
576Investigateurs
Michael Joannidis
(M)
Philipp Eller
(P)
Raimund Helbok
(R)
René Schmutz
(R)
Joke Nollet
(J)
Nikolaas de Neve
(N)
Pieter De Buysscher
(P)
Sandra Oeyen
(S)
Walter Swinnen
(W)
Marijana Mikačić
(M)
Anders Bastiansen
(A)
Andreas Husted
(A)
Bård E S Dahle
(BES)
Christine Cramer
(C)
Christoffer Sølling
(C)
Dorthe Ørsnes
(D)
Jakob Edelberg Thomsen
(JE)
Jonas Juul Pedersen
(JJ)
Mathilde Hummelmose Enevoldsen
(MH)
Thomas Elkmann
(T)
Agnieszka Kubisz-Pudelko
(A)
Alan Pope
(A)
Amy Collins
(A)
Ashok S Raj
(AS)
Carole Boulanger
(C)
Christian Frey
(C)
Ciaran Hart
(C)
Clare Bolger
(C)
Dominic Spray
(D)
Georgina Randell
(G)
Helder Filipe
(H)
Ingeborg D Welters
(ID)
Irina Grecu
(I)
Jane Evans
(J)
Jason Cupitt
(J)
Jenny Lord
(J)
Jeremy Henning
(J)
Joanne Jones
(J)
Jonathan Ball
(J)
Julie North
(J)
Kiran Salaunkey
(K)
Laura Ortiz-Ruiz De Gordoa
(LO)
Louise Bell
(L)
Madhu Balasubramaniam
(M)
Marcela Vizcaychipi
(M)
Maria Faulkner
(M)
Mc Donald Mupudzi
(MD)
Megan Lea-Hagerty
(M)
Michael Reay
(M)
Michael Spivey
(M)
Nicholas Love
(N)
Nick Spittle Nick Spittle
(NSN)
Nigel White
(N)
Patricia Williams
(P)
Patrick Morgan
(P)
Phillipa Wakefield
(P)
Rachel Savine
(R)
Reni Jacob
(R)
Richard Innes
(R)
Ritoo Kapoor
(R)
Sally Humphreys
(S)
Steve Rose
(S)
Susan Dowling
(S)
Susannah Leaver
(S)
Tarkeshwari Mane
(T)
Tom Lawton
(T)
Vongayi Ogbeide
(V)
Waqas Khaliq
(W)
Yolanda Baird
(Y)
Antoine Romen
(A)
Arnaud Galbois
(A)
Bertrand Guidet
(B)
Christophe Vinsonneau
(C)
Cyril Charron
(C)
Didier Thevenin
(D)
Emmanuel Guerot
(E)
Guillaume Besch
(G)
Guillaume Savary
(G)
Hervé Mentec
(H)
Jean-Luc Chagnon
(JL)
Jean-Philippe Rigaud
(JP)
Jean-Pierre Quenot
(JP)
Jeremy Castanera
(J)
Jérémy Rosman
(J)
Julien Maizel
(J)
Kelly Tiercelet
(K)
Lucie Vettoretti
(L)
Maud Mousset Hovaere
(MM)
Messika Messika
(M)
Michel Djibré
(M)
Nathalie Rolin
(N)
Philippe Burtin
(P)
Pierre Garcon
(P)
Saad Nseir
(S)
Xavier Valette
(X)
Christian Rabe
(C)
Eberhard Barth
(E)
Henning Ebelt
(H)
Kristina Fuest
(K)
Marcus Franz
(M)
Michael Horacek
(M)
Michael Schuster
(M)
Patrick Meybohm
(P)
Raphael Romano Bruno
(RR)
Sebastian Allgäuer
(S)
Simon Dubler
(S)
Stefan J Schaller
(SJ)
Stefan Schering
(S)
Stephan Steiner
(S)
Thorben Dieck
(T)
Tim Rahmel
(T)
Tobias Graf
(T)
Anastasia Koutsikou
(A)
Aristeidis Vakalos
(A)
Bogdan Raitsiou
(B)
Elli Niki Flioni
(EN)
Evangelia Neou
(E)
Fotios Tsimpoukas
(F)
Georgios Papathanakos
(G)
Giorgos Marinakis
(G)
Ioannis Koutsodimitropoulos
(I)
Kounougeri Aikaterini
(K)
Nikoletta Rovina
(N)
Stylliani Kourelea
(S)
Polychronis Tasioudis
(P)
Vasiiios Zidianakis
(V)
Vryza Konstantinia
(V)
Zoi Aidoni
(Z)
Brian Marsh
(B)
Catherine Motherway
(C)
Chris Read
(C)
Ignacio Martin-Loeches
(I)
Andrea Neville Cracchiolo
(AN)
Aristide Morigi
(A)
Italo Calamai
(I)
Stefania Brusa
(S)
Ahmed Elhadi
(A)
Ahmed Tarek
(A)
Ala Khaled
(A)
Hazem Ahmed
(H)
Wesal Ali Belkhair
(WA)
Alexander D Cornet
(AD)
Diederik Gommers
(D)
Dylan W De Lange
(DW)
Eva van Boven
(E)
Jasper Haringman
(J)
Lenneke Haas
(L)
Lettie van den Berg
(L)
Oscar Hoiting
(O)
Peter de Jager
(P)
Rik T Gerritsen
(RT)
Tom Dormans
(T)
Willem Dieperink
(W)
Alena Breidablik Alena Breidablik
(ABA)
Anita Slapgard
(A)
Anne-Karin Rime
(AK)
Bente Jannestad
(B)
Britt Sjøbøe
(B)
Eva Rice
(E)
Finn H Andersen
(FH)
Hans Frank Strietzel
(HF)
Jan Peter Jensen
(JP)
Jørund Langørgen
(J)
Kirsti Tøien
(K)
Kristian Strand
(K)
Michael Hahn
(M)
Pål Klepstad
(P)
Aleksandra Biernacka
(A)
Anna Kluzik
(A)
Bartosz Kudlinski
(B)
Dariusz Maciejewski
(D)
Dorota Studzińska
(D)
Hubert Hymczak
(H)
Jan Stefaniak
(J)
Joanna Solek-Pastuszka
(J)
Joanna Zorska
(J)
Katarzyna Cwyl
(K)
Lukasz J Krzych
(LJ)
Maciej Zukowski
(M)
Małgorzata Lipińska-Gediga
(M)
Marek Pietruszko
(M)
Mariusz Piechota
(M)
Marta Serwa
(M)
Miroslaw Czuczwar
(M)
Mirosław Ziętkiewicz
(M)
Natalia Kozera
(N)
Paweł Nasiłowski
(P)
Paweł Sendur
(P)
Paweł Zatorski
(P)
Piotr Galkin
(P)
Ryszard Gawda
(R)
Urszula Kościuczuk
(U)
Waldemar Cyrankiewicz
(W)
Wojciech Gola
(W)
Alexandre Fernandes Pinto
(A)
Ana Margarida Fernandes
(AM)
Ana Rita Santos
(AR)
Cristina Sousa
(C)
Inês Barros
(I)
Isabel Amorim Ferreira
(IA)
Jacobo Bacariza Blanco
(JB)
João Teles Carvalho
(JT)
Jose Maia
(J)
Nuno Candeias
(N)
Nuno Catorze
(N)
Vladislav Belskiy
(V)
Africa Lores
(A)
Angela Prado Mira
(AP)
Catia Cilloniz
(C)
David Perez-Torres
(D)
Emilio Maseda
(E)
Enver Rodriguez
(E)
Estefania Prol-Silva
(E)
Gaspar Eixarch
(G)
Gemma Gomà
(G)
Gerardo Aguilar
(G)
Gonzalo Navarro Velasco
(GN)
Marián Irazábal Jaimes
(MI)
Mercedes Ibarz Villamayor
(MI)
Noemí Llamas Fernández
(NL)
Patricia Jimeno Cubero
(PJ)
Sonia López-Cuenca
(S)
Teresa Tomasa
(T)
Anders Sjöqvist
(A)
Camilla Brorsson
(C)
Fredrik Schiöler
(F)
Henrik Westberg
(H)
Jessica Nauska
(J)
Joakim Sivik
(J)
Johan Berkius
(J)
Karin Kleiven Thiringer
(KK)
Lina De Geer
(L)
Sten Walther
(S)
Filippo Boroli
(F)
Joerg C Schefold
(JC)
Leila Hergafi
(L)
Philippe Eckert
(P)
Ismail Yıldız
(I)
Ihor Yovenko
(I)
Yuriy Nalapko
(Y)
Richard Pugh
(R)
Informations de copyright
© 2021. The Author(s).
Références
Intensive Care Med. 2020 Jan;46(1):57-69
pubmed: 31784798
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Intensive Care Med. 2012 Oct;38(10):1654-61
pubmed: 22797350
J Crit Care. 2019 Aug;52:141-148
pubmed: 31055187
J Am Geriatr Soc. 1983 Dec;31(12):721-7
pubmed: 6418786
J Gerontol A Biol Sci Med Sci. 2005 Jan;60(1):129-32
pubmed: 15741296
BMC Geriatr. 2018 Jul 13;18(1):162
pubmed: 30005622
Lancet. 2017 Apr 1;389(10076):1323-1335
pubmed: 28236464
JAMA. 2017 Oct 17;318(15):1450-1459
pubmed: 28973065
Intensive Care Med. 2007 Jul;33(7):1252
pubmed: 17404703
Psychol Med. 1989 Nov;19(4):1015-22
pubmed: 2594878
Surg Today. 2007;37(12):1064-7
pubmed: 18030567
Intensive Care Med. 2003 Dec;29(12):2137-2143
pubmed: 14614546
Arch Intern Med. 2000 Dec 11-25;160(22):3439-43
pubmed: 11112237
Circulation. 2007 May 1;115(17):2340-3
pubmed: 17470708
Resuscitation. 2018 Nov;132:6-12
pubmed: 30144464
Intensive Care Med. 2018 Jul;44(7):1027-1038
pubmed: 29774388
Intensive Care Med. 2018 Nov;44(11):1926-1928
pubmed: 29356853
Intensive Care Med. 2017 Dec;43(12):1820-1828
pubmed: 28936626
J Am Geriatr Soc. 2012 Aug;60(8):1465-70
pubmed: 22788674
Crit Care. 2005;9(6):R645-52
pubmed: 16280063
J Am Geriatr Soc. 2020 Jan;68(1):39-45
pubmed: 31840239
Intensive Care Med. 2015 Nov;41(11):1996-8
pubmed: 26359170
Crit Care. 2017 May 16;21(1):109
pubmed: 28506243
J Am Geriatr Soc. 2005 Jan;53(1):88-93
pubmed: 15667382
Ann Intensive Care. 2015 Dec;5(1):53
pubmed: 26690798
Intensive Care Med. 2012 Apr;38(4):620-6
pubmed: 22354500
Crit Care Med. 2020 Apr;48(4):466-474
pubmed: 32205592