Prognostic factors associated with adverse outcome among critically ill elderly patients admitted to the intensive care unit

Orsini, Jose; Butala, Ashvin; Salomon, Say; Studer, Sean M.; Gadhia, Shardul; Shamian, Ben; Prajapati, Ramesh; Blaak, Christa

doi:10.1111/ggi.12363

Cited by 18 publications

(19 citation statements)

References 31 publications

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“…The need for IMV was independently associated with hospital mortality. These results are in accordance with previous findings 13,20 . Farfel et al did not consider age as a factor associated with hospital mortality in the elderly with no need for IMV 21 .…”

Section: Discussionsupporting

confidence: 94%

Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit

Lucena¹,

Santos-Veloso²,

Xavier³

et al. 2019

Medicina (Ribeirao Preto Online)

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Study design: a descriptive, prospective cohort study. Objectives: identify the risk factors associated with SAPS 3 and APACHE II score to improve mortality prediction in elderly admitted in the intensive care unit (ICU). Methodology: a cohort study with 174 elderly patients admitted in ICU from July 2016 to June 2017. The primary independent variables analyzed were: presence of stress hyperglycemia, the need for invasive mechanical ventilation (IMV), acute renal failure, level of consciousness and use of vasopressors. The outcomes studied were death and hospital discharge. Results: ICU and hospital mortality were 17.8% and 29.8%, respectively. The multivariate analysis of factors associated with hospital death not contemplated in the obtaining of SAPS 3 demonstrated that IMV, Chronic Obstructive Pulmonary Disease (COPD) and Mean Arterial Pressure (MAP) <70 mmHg improved the prediction of mortality. The Hosmer-Lemeshow test (p=0.472) and area under ROC curve=0.80 (CI95%:0.731-0.872) confirmed, respectively, an appropriate calibration and acceptable-to-excellent discriminatory power for this model. IMV and COPD were also factors associated with the APACHE II score in prediction of mortality with appropriated calibration (p=0.471) and acceptable-to-excellent discriminatory power (area under ROC curve=0.80 [CI95%:0.730-0.868]). Conclusion: IMV, COPD, and MAP <70 mmHg were associated with SAPS3 and APACHE II to predict mortality in elderly admitted to ICU.

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Section: Discussionsupporting

confidence: 94%

Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit

Lucena¹,

Santos-Veloso²,

Xavier³

et al. 2019

Medicina (Ribeirao Preto Online)

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“…Several studies in developing countries have examined the clinical pattern of ICU admissions among the elderly and potential determinants of outcome including electrolyte imbalance, presence of co-morbidities, need for mechanical ventilation, sepsis and severity of illness. (10)(11)(12) However, there is paucity of data on this subject in Africa. The aim of this study was to assess the pattern and outcome of elderly admissions into the ICU of our hospital.…”

Section: Introductionmentioning

confidence: 99%

Pattern and outcome of elderly admissions into the Intensive Care Unit (ICU) of a low resource tertiary hospital

Owojuyigbe¹,

Adenekan²,

Babalola³

et al. 2016

East. Cent. Afr. J. Surg.

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Background: Globally, the population of the elderly is increasing and the greatest increase is occurring in the developing and middle income countries because of falling death rate and high birth rate. The ageing of the population in developing countries may result in increasing requirement for health care facilities including ICU care for the elderly. This study was aimed at assessing the pattern and outcome of elderly patients' admissions into the ICU of our hospital and identifies the determinants of outcome. Method: This was a retrospective study covering a 5 year period (January1 st 2010 to 31 st December 2014) in the ICU of a sub-Saharan tertiary hospital. Data was obtained from the review of ICU admission records over this period. We included as elderly patients aged 65years and above. Results: During the period under review, 90 cases were identified but only 62 cases were available for review (68.9%). There were 40 males and 22 females with ages ranging between 65 and 92years. Surgical admissions accounted for 75.8% of admissions while medical admissions were 24.2%. The overall ICU mortality in the elderly was 58.1%.The major predictors of mortality were: need for endotracheal intubation (p=0.001), mechanical ventilation (p=0.001), vasopressor (p=0.001), electrolyte derangement (p=0.001), sepsis on admission (p=0.001), shock on admission (p=0.001). Conclusion: Elderly patients admitted into the ICU are a population with an increased risk of mortality. The predictors of high risk of death are sepsis on admission, septic shock, need for vasopressor, endotracheal intubation and or mechanical ventilation and the presence of electrolyte derangement. The outcome of this study calls for a need to pay more attention to this rapidly expanding group of the population.

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“…Mechanical ventilation and inotropic support have been associated with mortality in patients admitted to ICU (14). In an ongoing Indian study, mechanical ventilation and inotropic support proved to increase mortality in geriatric patients (15).…”

Section: Discussionmentioning

confidence: 99%

“…In a study on 104 patients aged >85 years, van den Noortgate et al found inotropes as an independent risk factor in mortality (16). Orsini et al found that advanced age, critical illness, cardiopulmonary resuscitation, and needs for mechanical ventilation and/or vasopressor therapy are independent risk factors associated with adverse outcome in elderly patients admitted to ICU (14). Similar to these results, this investigation revealed that medical patients had higher APACHE II score, need for MV, need for inotropes, and mortality rate.…”

Section: Sim Et Al Have Found That High Simplified Acutementioning

confidence: 99%

Do Surgical Patients Older Than 90 Years More Benefit From Intensive Care Unit

Arıkan¹

2020

tjgeri

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The number of elderly patients followed in intensive care units is increasing day by day. In the literature, there are a limited number of studies covering patients aged 90 and over. We aimed to investigate the epidemiologic characteristics and clinical outcomes of elderly patients aged ≥90 years admitted to intensive care unit. Materials and Methods: In this study, medical records of patients aged ≥90 years admitted to intensive care unit, between January 2015 and January 2018, were retrospectively reviewed. Demographic data, reason for admission (medical or surgical), Acute Physical and Chronic Health Evaluation II (APACHE II) score, need for and duration of mechanical ventilation, need for inotropic agents, duration of intensive care unit stay, and mortality rate were recorded. Results: A total of 107 nonagenarians were evaluated. The mean age of the patients was 92.65 ± 2.36 years, and 72 of them were women. The mean score of APHACHE II was 23.6 ± 7.2. Most patients were admitted due to medical reasons (n = 82, 76.63%). Sixty-four of the medical patients, and four of the surgical patients had died in the intensive care unit (n = 68, 63.55%). APACHE II score, need for and the duration of mechanical ventilation, need for inotropic agents, the duration of intensive care unit stay, and the mortality rate were higher in medical patients than in surgical patients. Conclusions: The mortality rates of the medical patients were high; nevertheless, we believe that surgical patients more benefit from intensive care unit follow-up.

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Prognostic factors associated with adverse outcome among critically ill elderly patients admitted to the intensive care unit

Cited by 18 publications

References 31 publications

Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit

Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit

Pattern and outcome of elderly admissions into the Intensive Care Unit (ICU) of a low resource tertiary hospital

Do Surgical Patients Older Than 90 Years More Benefit From Intensive Care Unit

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