Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU.
Clustering analysis
Geriatric patients
Heterogeneity
Intensive care
Phenotyping
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
05
05
2022
accepted:
11
08
2022
pubmed:
3
9
2022
medline:
1
12
2022
entrez:
2
9
2022
Statut:
ppublish
Résumé
The biological and functional heterogeneity in very old patients constitutes a major challenge to prognostication and patient management in intensive care units (ICUs). In addition to the characteristics of acute diseases, geriatric conditions such as frailty, multimorbidity, cognitive impairment and functional disabilities were shown to influence outcome in that population. The goal of this study was to identify new and robust phenotypes based on the combination of these features to facilitate early outcome prediction. Patients aged 80 years old or older with and without limitations of life-sustaining treatment and with complete data were recruited from the VIP2 study for phenotyping and from the COVIP study for external validation. The sequential organ failure assessment (SOFA) score and its sub-scores taken on admission to ICU as well as demographic and geriatric patient characteristics were subjected to clustering analysis. Phenotypes were identified after repeated bootstrapping and clustering runs. In patients from the VIP2 study without limitations of life-sustaining treatment (n = 1977), ICU mortality was 12% and 30-day mortality 19%. Seven phenotypes with distinct profiles of acute and geriatric characteristics were identified in that cohort. Phenotype-specific mortality within 30 days ranged from 3 to 57%. Among the patients assigned to a phenotype with pronounced geriatric features and high SOFA scores, 50% died in ICU and 57% within 30 days. Mortality differences between phenotypes were confirmed in the COVIP study cohort (n = 280). Phenotyping of very old patients on admission to ICU revealed new phenotypes with different mortality and potential need for anticipatory intervention.
Identifiants
pubmed: 36056194
doi: 10.1007/s00134-022-06868-x
pii: 10.1007/s00134-022-06868-x
pmc: PMC9439274
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1726-1735Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.
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