Critically ill patient mortality by age: long-term follow-up (CIMbA-LT)

Annals of Intensive Care

Research

José-Artur Paiva¹  Maria João Pinto²  Ana Martinho³  Ana Rita Rodrigues⁴  Tatiana Vieira⁵  Sofia Ribeiro⁶  Sara Pipa⁷  André Oliveira⁸  João Gonçalves-Pereira⁹ 

[1] Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Porto, Portugal;Intensive Care Department, Centro Hospitalar Universitário de S. João, Porto, Portugal;Faculdade de Medicina, Universidade do Porto, Porto, Portugal;Intensive Care Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal;Intensive Care Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal;Intensive Care Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal;Intensive Care Department, Centro Hospitalar Universitário de S. João, Porto, Portugal;Intensive Care Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal;Intensive Care Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal;Intensive Care Unit, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa, N2, 2600-009, Vila Franca de Xira, Portugal;Intensive Care Unit, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa, N2, 2600-009, Vila Franca de Xira, Portugal;Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal;Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Porto, Portugal;

关键词: Follow-up;    Long term;    Age;    Survival;    Mortality;    SAPS-II;    Standard mortality ratio;   

DOI  :  10.1186/s13613-023-01102-3

 received in 2022-11-16, accepted in 2023-01-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied.MethodsThe Critically Ill patients’ mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group.ResultsWe included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63–0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98–1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8–6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1–39.6) vs. 2.4; (95% CI 2.2–2.7) for older patients].ConclusionsCritically ill patients’ mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 3

Fig. 6

Fig. 8

Fig. 1

Fig. 1