Intensive care use and mortality in the very elderly patients

Introduction

The purpose of the study was to focus on factors that affected outcome of very elderly patients (≥ 75 years) in a 10-bed polyvalent ICU.

Methods

A retrospective database analysis of admissions from January 2003 to June 2006. The variables recorded were: age, admission diagnosis, severity of illness scores, mechanical ventilation days, ventilator-acquired pneumonia, and ICU length of stay. According to the ICU outcome, patients were divided into survivors and nonsurvivors. Statistics were performed by Mann–Whitney, chi-square, multivariate logistic regression and ROC curve analyses.

Results

Very elderly patients comprised 10.7% (n = 131) of the study population (n = 1,223). The mean age was 78 ± 4 years (range 75–96). Patient data according to outcome and statistical significance are presented in Tables 1 and 2. The APACHE II (OR: 1.153, 95% CI: 1.011–1.315, P = 0.033) and SOFA scores (OR: 1.724, 95% CI: 1.189–2.499, P = 0.004) upon ICU admission were determined as independent risk factors affecting outcome. ROC curve analysis revealed that admission APACHE II (>23) and SOFA (>4) scores presented a sensitivity of 77.4% and 96.8%, respectively, with a specificity of 95% and 74%, respectively, for the prediction of poor outcome. The total mortality rate was 23.7% (n = 31).

Table 1 Patient data 1

Table 2 Patient data 2

Conclusion

It is not age per se but concomitant factors that appear to be responsible for the poorer prognosis. Among them, severity of illness and premorbid functional status are identified as strong predictors of adverse ICU outcome.