Outcome of Older Patients Requiring Ventilatory Support in Intensive Care: Impact of Nutritional Status

Dardaine, V.; Dequin, Pierre‐François; Ripault, Héliette; Constans, T.; Giniès, G

doi:10.1046/j.1532-5415.2001.49114.x

Cited by 50 publications

(46 citation statements)

References 63 publications

(117 reference statements)

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“…Among them, 39% were 80 years and older. This result was in accordance with previous reports focused on the oldest patients in the ICU, ≥ 70 yrs [6,26], ≥ 75 yrs [25], or ≥ 80 yrs [3,24], but differed from the 9% recently reported [27], suggesting a more restrictive admission policy in the latter. Despite a median Charlson index of 6 [IQR, 4 to 7] corresponding to a high comorbidity level, patients assessed by ADL and cognitive indices had a low physical and cognitive dependence level.…”

Section: Discussionsupporting

confidence: 91%

Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Daubin

Chevalier

Seguin

et al. 2011

Health and Quality of Life Outcomes

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BackgroundThe purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors.MethodsWe conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score.ResultsOne hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life.ConclusionsIn a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.

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Section: Discussionsupporting

confidence: 91%

Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Daubin

Chevalier

Seguin

et al. 2011

Health and Quality of Life Outcomes

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“…16,17,26 Various nutritional markers, individually or collectively, are associated with prognosis in older patients, but confounding remains uncertain. 5,17,18,20,[26][27][28][29][30][31][32] Several methods used to assess nutritional or functional status require complex scoring systems, or additional measurements such as skin fold or arm circumflex; in contrast, the nutritional index employed in the present study comprised only body mass index scores and simple biochemical parameters routinely measured in patients admitted to the ICU. This nutritional score can be easily used to predict the progress of very elderly patients admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Nutritional status was assessed according to a single anthropometric value (body mass index) and 3 routine laboratory tests (serum albumin, serum cholesterol, lymphocyte count), which are known to be simple parameters associated with nutritional status. 5,[16][17][18][19][20][21][22] Poor nutrition was defined as having at least 3 of the following: body mass index Ͻ 18.5 kg/m 2 , serum albumin Ͻ 3.0 g/dL, serum cholesterol Ͻ 130 mg/dL, and total lymphocyte count Ͻ 1,000/mm 3 . 5,[16][17][18][19][20][21][22] Subjects Ն 90 y of age who were admitted to the ICU and for whom DNR orders were in effect received all indicated medical treatments except for cardiopulmonary resuscitation.…”

Section: Variablesmentioning

confidence: 99%

“…1 Although age is thought of as a strong prognostic factor for critical care, some studies have included other predictive factors such as severity of illness, reason for admission, and underlying condition as well. 1,[5][6][7][8][9][10][11] However, in elderly patients admitted to the ICU, life-sustaining treatments are more often withdrawn and invasive treatments tend to be avoided. 12,13 Thus, analysis of the outcomes and prognoses of very elderly patients admitted to the ICU is important in terms of the provision of information to the medical team, patients, and families for advanced care planning and decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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BACKGROUND:We evaluated the clinical characteristics and factors associated with mortality in very elderly patients > 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects > 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects > 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects > 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P ‫؍‬ .006), poor nutrition (P ‫؍‬ .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P ‫؍‬ .002), and vasopressor treatment (P ‫؍‬ .03) were independent predictive factors of mortality in subjects > 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (> 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

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“…Severity of illness and age appear to be important factors determining ICU survival. [16][17][18][19] In both the acute physiology and chronic health evaluation (APACHE II) and APACHE III disease severity and outcome predictive systems, increasing age was associated with a progressive increase in the risk of ICU death. 20,21 Nicholas et al 18 analyzed the influence of age on ICU survival from data collected on 792 admissions to 8 ICUs in France.…”

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confidence: 99%

Should Age Limit Admission to the Intensive Care Unit?

Marik

2007

Am J Hosp Palliat Care

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People who are older than 65 years of age are the fastest growing segment of the United States population. With the projected exponential increase in the number of elderly patients and the increasing burden of chronic disease, the number of elderly patients who will require treatment in an intensive care unit is expected to increase. Owing to the elderly patient's reduced life expectancy and higher intensive care unit and hospital mortality, it could be argued that elderly patients should not be admitted to the intensive care unit. However, an analysis of available data suggests that functional elderly patients have a favorable "long-term" outcome after intensive care unit admission. This suggests that age alone should not be used in making intensive care unit triage decisions.

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Outcome of Older Patients Requiring Ventilatory Support in Intensive Care: Impact of Nutritional Status

Cited by 50 publications

References 63 publications

Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Should Age Limit Admission to the Intensive Care Unit?

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