Premorbid functional status as a predictor of 1-year mortality and functional status in intensive care patients aged 80 years or older
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We assessed the association between the premorbid functional status (PFS) and 1-year mortality and functional status of very old intensive care patients.
Using a nationwide quality registry, we retrieved data on patients treated in Finnish intensive care units (ICUs) during the period May 2012‒April 2013. Of 16,389 patients, 1827 (11.1%) were very old (aged 80 years or older). We defined a person with good functional status as someone independent in activities of daily living (ADL) and able to climb stairs without assistance; a person with poor functional status was defined as needing assistance for ADL or being unable to climb stairs. We adjusted for severity of illness and calculated the impact of PFS.
Overall, hospital mortality was 21.3% and 1-year mortality was 38.2%. For emergency patients (73.5% of all), hospital mortality was 28% and 1-year mortality was 48%. The functional status at 1 year was comparable to the PFS in 78% of the survivors. PFS was poor for 43.3% of the patients. A poor PFS predicted an increased risk of in-hospital death, adjusted odds ratio (OR) 1.50 (95% confidence interval, 1.07–2.10), and of 1-year mortality, OR 2.18 (1.67–2.85). PFS data significantly improved the prediction of 1-year mortality.
Of very old ICU patients, 62% were alive 1 year after ICU admission and 78% of the survivors had a functional status comparable to the premorbid situation. A poor PFS doubled the odds of death within a year. Knowledge of PFS improved the prediction of 1-year mortality.
KeywordsVery old Intensive care ICU Mortality Functional status Frailty
List of contributors: Satakunta Central Hospital, Pori: Vesa Lund, Pauliina Perkola, Riikka Virtanen; Central Hospital of Savonlinna, Savonlinna: Katrine Pesola, Anne Solonen, Tiina Kettunen; Central Finland Central Hospital, Jyväskylä: Raili Laru-Sompa, Mikko Reilama; Mikkeli Central Hospital, Mikkeli: Heikki Laine, Sari Paunonen; North Karelia Central Hospital, Joensuu: Matti Reinikainen, Helena Jyrkönen, Tanja Eiserbeck, Tero Surakka; Southern Ostrobothnia Central Hospital, Seinäjoki: Kari Saarinen, Pauliina Lähdeaho; South Karelia Central Hospital, Lappeenranta: Seppo Hovilehto, Sari Kontula, Kati Hietala; Päijät-Häme Central Hospital, Lahti: Pekka Loisa, Pirjo Tuomi, Alli Parviainen; Central Hospital of Kainuu, Kajaani: Sami Mäenpää, Marko Pohjanpaju, Kari Auvinen; Vaasa Central Hospital, Vaasa: Simo-Pekka Koivisto; Central Hospital of Tavastia, Hämeenlinna: Ari Alaspää, Tarja Heikkilä, Piia Laitinen; Helsinki University Hospital, Jorvi Hospital, Espoo: Johanna Hästbacka, Taina Nieminen, Mira Rahkonen, Niina Prittinen; Helsinki University Central Hospital, Meilahti Hospital, Helsinki: Raili Suojaranta, Elina Lappi, Marja Hynninen, Kaija Kiljunen; Lapland Central Hospital, Rovaniemi: Outi Kiviniemi, Sirpa Suominen, Esa Lintula; Middle Ostrobothnia Central Hospital, Kokkola: Tadeusz Kaminski, Tuija Kuusela, Jane Roiko; Kymenlaakso Central Hospital, Kotka: Reija Koskinen, Miia Härmä; Turku University Hospital, Turku: Ruut Laitio, Jutta Kotamäki, Satu Kentala, Eveliina Loikas, Päivi Haltia, Keijo Leivo; Tampere University Hospital, Tampere: Sari Karlsson, Auli Palmu, Kati Järvelä, Minna-Liisa Peltola; Central Hospital of Länsi-Pohja, Kemi: Jorma Heikkinen, Anne-Mari Juopperi; Kuopio University Hospital, Kuopio: Ilkka Parviainen, Saija Rissanen, Elina Halonen, Sari Rahikainen; Oulu University Hospital, Oulu: Tero Ala-Kokko, Sinikka Sälkiö.
We thank biostatistician Tuomas Selander, MSc, for help with the statistical analyses, and Tieto Ltd for good collaboration with retrieving data from the FICC database. The study was supported by an institutional research grant from Kuopio University Hospital (code EVO 5070241).
Compliance with ethical standards
Conflicts of interest
Dr Hästbacka has received reimbursement for research meeting travel expenses from LaJolla Pharmaceutical and compensation for consulting from Pfizer. The other authors have no conflicts of interests.
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