Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study.

Aged Aged, 80 and over Critical Illness Hospital Mortality Hospitalization Humans Intensive Care Units Prospective Studies
Europe cohort studies critical care outcomes critical illness intensive care unit mortality old patients outcome assessment variation

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
07 2022
Historique:
received: 04 01 2021
revised: 27 03 2022
accepted: 27 03 2022
pubmed: 3 5 2022
medline: 23 6 2022
entrez: 2 5 2022
Statut: ppublish

Résumé

Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs). Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97]). The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation.

Sections du résumé

BACKGROUND
Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients.
METHODS
Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs).
RESULTS
Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97]).
CONCLUSION
The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation.

Identifiants

DOI: 10.1016/j.bja.2022.03.026 PMID: 35501185
pubmed: 35501185
pii: S0007-0912(22)00156-8
doi: 10.1016/j.bja.2022.03.026
pii:
doi:

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

58-66

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

Jakub Fronczek (J)

Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.

Hans Flaatten (H)

Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Bertrand Guidet (B)

Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France; Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.

Kamil Polok (K)

Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.

Finn H Andersen (FH)

Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway; Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.

Benjamin Y Andrew (BY)

Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.

Antonio Artigas (A)

Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.

Michael Beil (M)

Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.

Maurizio Cecconi (M)

Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy.

Steffen Christensen (S)

Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

Dylan W de Lange (DW)

Department of Intensive Care Medicine, University Medical Center, University of Utrecht, Utrecht, the Netherlands.

Jesper Fjølner (J)

Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

Jacek Górka (J)

Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.

Michael Joannidis (M)

Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.

Christian Jung (C)

Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.

Krzysztof Kusza (K)

Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland.

Susannah Leaver (S)

Critical Care Directorate, St George's Hospital, London, UK.

Brian Marsh (B)

Mater Misericordiae University Hospital, Dublin, Ireland.

Alessandro Morandi (A)

Department of Rehabilitation Hospital Ancelle di Cremona Italy, Geriatric Research Group, Brescia, Italy.

Rui Moreno (R)

Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.

Sandra Oeyen (S)

Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.

Radosław Owczuk (R)

Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk, Gdańsk, Poland.

Christina Agvald-Öhman (C)

Karolinska University Hospital, Stockholm, Sweden.

Bernardo B Pinto (BB)

Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.

Andrew Rhodes (A)

St George's University Hospitals NHS Foundation Trust, London, UK.

Joerg C Schefold (JC)

Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Ivo W Soliman (IW)

Department of Intensive Care Medicine, University Medical Center, University of Utrecht, Utrecht, the Netherlands.

Andreas Valentin (A)

Kardinal Schwarzenberg Hospital, Schwarzach, Austria.

Sten Walther (S)

Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Linköping University Hospital, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.

Ximena Watson (X)

St George's University Hospitals NHS Foundation Trust, London, UK.

Tilemachos Zafeiridis (T)

Intensive Care Unit, General Hospital of Larissa, Larissa, Greece.

Wojciech Szczeklik (W)

Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland. Electronic address: wojciech.szczeklik@uj.edu.pl.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Short-term mortality of patients ≥80 years old...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Short-term mortality of patients ≥80 years old...