Prognosis of Very Elderly Patients After Intensive Care

Author(s):  
Philippe Michel ◽  
Fouad FADEL ◽  
Gaëtan Plantefève ◽  
Stephan Ehrmann ◽  
bruno Gelée

Abstract Background: Very elderly patients (aged over 85 years) are increasingly treated in intensive care units (ICU) despite the reluctance of doctors to admit these patients considered fragile. Only a few studies in this age group have described the relevance of treatment of these patients in the intensive care unit. Methods: he inclusion criterion for this study was patients aged 85 years or over on admission. The exclusion criteria were high dependence before admission or an inability to answer the telephone. Epidemiological data, antecedents, lifestyle, autonomy (ADL score of six items) were recorded on admission to the ICU and by telephone interview at six months. Results: Eight French ICU included 239 patients aged over 85 years. The most common diagnoses were non-cradiogenic lung disease (36%), severe sepsis / septic shock (29%) and acute pulmonary oedema (28%). 23% of patients were dependent on admission. 71% of patients were still living when discharged from the ICU and 52% were still living at 6 months. Among the non-dependent patients before hospitalisation, 17% became dependent. The only prognostic criteria found were the SAPS II score on admission and the place of residence before admission (nursing home or ”with family” had a poor prognosis). Conclusions: Although the prognosis of these very elderly patients was good after hospitalisation in the ICU, it should be noted that the population was highly selected with few comorbidities or dependence. No triage criteria could be proposed. ClinicalTrials.gov Identifier: NCT02849756

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Alexandra Poell ◽  
Hinnerk Baecker ◽  
Sven Frieler ◽  
Christian Waydhas ◽  
...  

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69–140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28–71.9; p = 0.028) and CCI (OR 1.5, CI 1.004–2.12; p = 0.048) were independent risk factors for mortality. Conclusion Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.


2018 ◽  
Vol 46 (1) ◽  
pp. 235-235
Author(s):  
Nicolas Chin-Yee ◽  
Gianni D’Egidio ◽  
Kednapa Thavorn ◽  
Sasha Van Katwyk ◽  
Daren Heyland ◽  
...  

2015 ◽  
Vol 29 (4) ◽  
pp. 324-335 ◽  
Author(s):  
Daren K Heyland ◽  
Peter Dodek ◽  
Sangeeta Mehta ◽  
Deborah Cook ◽  
Allan Garland ◽  
...  

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. Aim: To describe family members’ perspectives about care provided to very elderly critically ill patients. Design: Multicenter, prospective, cohort study. Participants and setting: In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h. Results: Family members reported that the “patient be comfortable and suffer as little as possible” was their most important value and “the belief that life should be preserved at all costs” was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient’s care. Conclusion: There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.


2011 ◽  
Vol 19 (6) ◽  
pp. 1344-1351 ◽  
Author(s):  
Verônica Cunha Rodrigues de Oliveira ◽  
Lilia de Souza Nogueira ◽  
Rafaela Andolhe ◽  
Katia Grillo Padilha ◽  
Regina Marcia Cardoso de Sousa

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥18 and <60 years), 216 elderly (≥60 and <80 years) and 105 very elderly (≥80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3900-3900
Author(s):  
Madalena Silva ◽  
Luisa Checa ◽  
Fatima Costa ◽  
Rui Moreno ◽  
Eduardo G. Silva ◽  
...  

Abstract The admission of neutropenic patients (pts) to intensive care units (ICU) is controversial, especially when mechanical ventilation is required. Knowledge of the relative prognostic impact of factors related to the underlying disease and to the severity of acute organ failures might help avoiding futile admissions. We retrospectively assessed predictors of 30-day mortality in neutropenic (&lt;1000/ul) pts referred from a single Hematology unit to the 2 ICUs of the institution over a 10-year period. Of 66 consecutive pts, median age 48 (15–73), 82% had acute leukemia (AL) and 21% were in complete remission (CR). On ICU admission 62% of the pts had a neutrophil count ≤500/ul; microbiologically documented infection was found in 42%. The main reason for ICU referral was severe sepsis or septic shock in 62% of the cases and respiratory failure in 38%. Seventy per cent of the pts were already on vasopressor agents. At ICU entry the median Simplified Acute Physiology Score (SAPS) II was 63 and 26% of pts had ≥ 2 acute organ system failures (OSF). Coma was present in 23%. Mechanical ventilation was eventually needed in 89% and dialysis in 9% of the pts. Mortality at 30 days was 73%. By univariate logistic regression analysis mortality was not significantly related to age, to status of underlying disease (CR vs no CR/not yet known) to duration of neutropenia nor to depth of neutropenia at entry (≤ 500 vs &gt;500/ul). Pts who died were more likely to have non-M3 AL subtype vs M3 (p=0.037), to have ≥ 2 acute OSF vs &lt; 2 (p=0.012) and a higher SAPS II score (p&lt; 0.001). In multivariate analysis only the latter 2 variables remained significant. In conclusion, our data show that 27% of neutropenic pts admitted to ICUs are alive at 30 days; that selection for admission should not be based on the characteristics of the underlying malignancy; and that the 30-day mortality is highly predictable by initial acute illness severity scores.


2011 ◽  
Vol 27 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Prashant Nasa ◽  
Deven Juneja ◽  
Omender Singh ◽  
Rohit Dang ◽  
Vikas Arora

2010 ◽  
Vol 18 (2) ◽  
pp. 231-237 ◽  
Author(s):  
Yasser Sakr ◽  
Juliana Marques ◽  
Stefan Mortsch ◽  
Matheus Demarchi Gonsalves ◽  
Khosro Hekmat ◽  
...  

2015 ◽  
Vol 42 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Tetsu Ohnuma ◽  
Shigehiko Uchino ◽  
Noriyoshi Toki ◽  
Kenta Takeda ◽  
Yoshitomo Namba ◽  
...  

Background/Aims: Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database. Methods: New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration). Results: The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability. Conclusions: Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tianyang Hu ◽  
Huajie Lv ◽  
Youfan Jiang

AbstractSeveral commonly used scoring systems (SOFA, SAPS II, LODS, and SIRS) are currently lacking large sample data to confirm the predictive value of 30-day mortality from sepsis, and their clinical net benefits of predicting mortality are still inconclusive. The baseline data, LODS score, SAPS II score, SIRS score, SOFA score, and 30-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) intensive care unit (ICU) database. Receiver operating characteristic (ROC) curves and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits between the four scoring systems and 30-day mortality of sepsis. For all cases in the cohort study, the AUC of LODS, SAPS II, SIRS, SOFA were 0.733, 0.787, 0.597, and 0.688, respectively. The differences between the scoring systems were statistically significant (all P-values < 0.0001), and stratified analyses (the elderly and non-elderly) also showed the superiority of SAPS II among the four systems. According to the DCA, the net benefit ranges in descending order were SAPS II, LODS, SOFA, and SIRS. For stratified analyses of the elderly or non-elderly groups, the results also showed that SAPS II had the most net benefit. Among the four commonly used scoring systems, the SAPS II score has the highest predictive value for 30-day mortality from sepsis, which is better than LODS, SIRS, and SOFA. The results of the DCA curves show that using the SAPS II score to predict the 30-day mortality of intensive care patients with sepsis to guide clinical applications may obtain the highest net benefit.


PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241590
Author(s):  
Patrick Leiser ◽  
Thomas Kirschning ◽  
Christel Weiß ◽  
Michael Hagmann ◽  
Jochen Schoettler ◽  
...  

Objectives The aim of this study was to establish quantitative CT (qCT) parameters for pathophysiological understanding and clinical use in patients with acute respiratory distress syndrome (ARDS). The most promising parameter is introduced. Materials and methods 28 intubated patients with ARDS obtained a conventional CT scan in end-expiratory breathhold within the first 48 hours after admission to intensive care unit (ICU). Following manual segmentation, 137 volume- and lung weight-associated qCT parameters were correlated with 71 clinical parameters such as blood gases, applied ventilation pressures, pulse contour cardiac output measurements and established status and prognosis scores (SOFA, SAPS II). Results Of all examined qCT parameters, excess lung weight (ELW), i.e. the difference between a patient’s current lung weight and the virtual lung weight of a healthy person at the same height, displayed the most significant results. ELW correlated significantly with the amount of inflated lung tissue [%] (p<0.0001; r = -0.66) and was closely associated with the amount of extravascular lung water (EVLW) (p<0.0001; r = 0.72). More substantially than the oxygenation index (PaO2/FiO2) or any other clinical parameter it correlated with the patients’ mean SOFA- (p<0.0001, r = 0.69) and SAPS II-Score (p = 0.0005, r = 0.62). Patients who did not survive intensive care treatment displayed higher values of ELW in the initial CT scans. Conclusions ELW could serve as a non-invasive method to quantify the amount of pulmonary oedema. It might serve as an early radiological marker of severity in patients with ARDS.


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