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

Frontiers in Medicine

article

Raphael Romano Bruno¹  Dylan W. De Lange²  Daniel Dankl³  Andreas Koköfer³  Thomas Danninger³  Wojciech Szczeklik⁴  Sviri Sigal⁵  Peter Vernon van Heerden⁶  Michael Beil⁵  Jesper Fjølner⁷  Susannah Leaver⁸  Bernhard Wernly³  Hans Flaatten^1,11  Venet Osmani^1,12  Christian Jung¹  Behrooz Mamandipoor^1,12  Richard Rezar⁹  Stephan Binnebössel¹  Philipp Heinrich Baldia¹  Georg Wolff¹  Malte Kelm¹  Bertrand Guidet^1,13 

[1] Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf;Department of Intensive Care Medicine, University Medical Center, University Utrecht;Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg;Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College;Medical Intensive Care Unit, Hadassah University Hospital;General Intensive Care Unit, Hadassah University Hospital;Department of Intensive Care, Aarhus University Hospital;Research Lead Critical Care Directorate St George's Hospital, United Kingdom;Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg;Department of Cardiology, Paracelsus Medical University of Salzburg;Department of Intensive Care, Anesthesia and Surgical Services, Haukeland University Hospital Bergen;Fondazione Bruno Kessler Research Institute;Hôpital Saint-Antoine;Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique

关键词: sepsis;    intensive care;    critically ill;    obesity;    old;    very old;    octogenarian;    geriatric;   

DOI  :  10.3389/fmed.2021.697884

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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 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.

【 授权许可】

CC BY