TY - JOUR
T1 - Management and outcomes in critically ill nonagenarian versus octogenarian patients
AU - on behalf of the VIP2 study group
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Kelm, Malte
AU - Boumendil, Ariane
AU - Morandi, Alessandro
AU - Andersen, Finn H.
AU - Artigas, Antonio
AU - Finazzi, Stefano
AU - Cecconi, Maurizio
AU - Christensen, Steffen
AU - Faraldi, Loredana
AU - Lichtenauer, Michael
AU - Muessig, Johanna M.
AU - Marsh, Brian
AU - Moreno, Rui
AU - Oeyen, Sandra
AU - Öhman, Christina Agvald
AU - Pinto, Bernardo Bollen
AU - Soliman, Ivo W.
AU - Szczeklik, Wojciech
AU - Valentin, Andreas
AU - Watson, Ximena
AU - Leaver, Susannah
AU - Boulanger, Carole
AU - Walther, Sten
AU - Schefold, Joerg C.
AU - Joannidis, Michael
AU - Nalapko, Yuriy
AU - Elhadi, Muhammed
AU - Fjølner, Jesper
AU - Zafeiridis, Tilemachos
AU - De Lange, Dylan W.
AU - Guidet, Bertrand
AU - Flaatten, Hans
AU - Jung, Christian
AU - Joannidis, Michael
AU - Eller, Philipp
AU - Helbok, Raimund
AU - Schmutz, René
AU - Nollet, Joke
AU - de Neve, Nikolaas
AU - Buysscher, Pieter De
AU - Oeyen, Sandra
AU - Swinnen, Walter
AU - Mikačić, Marijana
AU - Bastiansen, Anders
AU - Husted, Andreas
AU - Dahle, Bård E.S.
AU - Cramer, Christine
AU - Faulkner, Maria
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration: NCT03134807 and NCT03370692.
AB - Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration: NCT03134807 and NCT03370692.
KW - Frailty
KW - Intensive care medicine
KW - Nonagenarians
KW - Octogenarians
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85117944534&partnerID=8YFLogxK
U2 - 10.1186/s12877-021-02476-4
DO - 10.1186/s12877-021-02476-4
M3 - Article
C2 - 34666709
AN - SCOPUS:85117944534
SN - 1471-2318
VL - 21
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 576
ER -