ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Abstract

Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.

The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

“…Old patients make up the subgroup of intensive care unit patients with the highest mortality [3]. However, the chronological age is a worse parameter for the outcome prediction of critically ill older patients [4,5]. This is particularly true for SARS-CoV-2 and its disease COVID-19, which challenge intensive care units worldwide [6].…”

The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data

“…Patient baseline characteristics were analysed as frequencies and percentages for categorical variables and as medians and interquartile ranges (IQRs) for continuous variables. Age groups were stratified a priori into patients < 65 years and ≥ 65 years [ 7 ]. Comparisons between age groups were evaluated using the Wilcoxon test for continuous variables and the χ2 or Fisher exact test for categorical variables as appropriate.…”

“…This is relevant as old patients are the fastest growing subgroup in intensive care medicine [ 6 ]. These old and very old patients have thus become a focus of research; it is now a consensus that chronological age alone is not a suitable criterion for assessing the prognosis of critically ill ICU patients [ 7 ]. Away from clinical trials, "ageism" is a common problem [ 8 , 9 ].…”

The impact of ethnic background on ICU care and outcome in sepsis and septic shock – A retrospective multicenter analysis on 17,949 patients

“…The database is released under the Health Insurance Portability and Accountability Act (HIPAA) safe harbor provision. As described previously, we extracted the baseline characteristics and organ support on day one [20][21][22].…”