Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.

Abstract Background: Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection (ARI) have increased, yet the long-term effect of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.Methods: We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.Results: 1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.Conclusions: We observed a substantially increased rate of death in the years after ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.Funding: None

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Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.

10.21203/rs.2.22685/v1 ◽

2020 ◽

Author(s):

Antoine Guillon ◽

C. Hermetet ◽

K. A. Barker ◽

Y. Jouan ◽

C. Gaborit ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Elderly Patients ◽

Healthcare Utilization ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Risk Of Death ◽

Before And After ◽

Frailty Score

Abstract BackgroundIntensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection (ARI) have increased, yet the long-term effect of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.MethodsWe used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 4-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.Results1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.ConclusionsWe observed a substantially increased rate of death in the years after ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.

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Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.

10.21203/rs.2.22685/v3 ◽

2020 ◽

Author(s):

Antoine Guillon ◽

C. Hermetet ◽

K. A. Barker ◽

Y. Jouan ◽

C. Gaborit ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Elderly Patients ◽

Healthcare Utilization ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Risk Of Death ◽

Before And After ◽

Frailty Score

Abstract Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.Methods We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.Results 1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.Conclusions We observed a substantially increased rate of death in the years following ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.Funding: None

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Acute respiratory infection hospitalized in intensive care unit: long-term outcome in Elderly

European Journal of Public Health ◽

10.1093/eurpub/ckz185.622 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

L Grammatico-Guillon ◽

C Hermetet ◽

C Gaborit ◽

L Laporte ◽

A Guillon

Keyword(s):

High Risk ◽

Propensity Score ◽

Elderly Patients ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Risk Groups ◽

Healthcare Consumption ◽

Risk Of Death ◽

Frailty Score

Abstract Background The consequences of the ageing population concerning ICU-hospitalization need to be adequately described, especially acute respiratory infections (ARI) strongly associated with Elderly. The study aimed to assess the long-term outcomes of ARI surviving ICU hospitalization in patients over 80 yo. Methods A retrospective multicentre cohort study was performed, based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with ARI in ICU were selected according to specific ICD-10 diagnosis codes recorded and matched with a control population (patient undergoing a cataract surgery), using a propensity score (matching algorithm 1:1 ratio, caliper 0.002) with the matching variables (age, sex, frailty score, chronic heart disease, chronic pulmonary disease and cancer). Analyzes of this matched population were performed to determine their 2-year in-hospital mortality, healthcare utilization and evolution of the frailty score during the 2-year period before/after the inclusion stay. Results A total of 1,658 hospital stays for ARI after 80 yo were identified, with 438 dead (26%) during the initial stay. After matching with the cataract population, 988 patients were selected in each group without difference in the propensity score. ARI lead to an important increase of healthcare use during the 2 years after discharge. The patients that were discharged from hospital after ARI requiring ICU, had a 23-fold increase of death at 90 days and 4-fold at 2 years and the evolution of the frailty score was 1.6 fold higher than the cataract population. Conclusions Elderly patients with severe ARI survived from their ICU stay in 75%, but have a major risk of death in the following months, and an important increase in healthcare consumption. Our findings provide data for more informed goals-of-care discussions and may help target post-ICU discharge services for these high-risk groups. Key messages Elderly patients with severe acute respiratory infection survived ICU in 75%, but had a major risk of death in the following months, added to a substantial increase in healthcare consumption. These findings provide data for more informed goals-of-care discussions and may help target interventions for these high-risk groups.

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