Severity of disease and infection were related to bad outcomes of elderly patients in a general ICU
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KeywordsElderly Patient Elderly Group Inotropic Agent Nutritional Therapy Sofa Score
Elderly patients (≥ 70 years old) are progressively more frequently admitted to ICUs. Studies addressed to evaluate short-term and long-term outcomes of the elderly were not conclusive about the effect of age as a predictor of bad outcomes. This study was designed to evaluate our experience in managing elderly patients admitted in our 21-bed medical-surgical ICU.
To evaluate which of the patients' characteristics and interventions were related to outcomes in elderly patients admitted in a general ICU.
A prospective cohort study, including all consecutive patients (n = 788) admitted from December 2003 to December 2004. Variables included for analysis were: demographic, diagnosis, severity scores at entrance; intervention issues during ICU stay: TISS28, organ dysfunction, mechanical ventilation, vasoactive medication, procedures, clinical infection and complications; outcomes recorded were: ICU and hospital length of stay, ventilator-days, mortality. Elderly patients' characteristics and outcomes were compared with the less old (<70 years old).
The elderly were 426 (54.06%) patients and the less-old group was 362 (45.93%). Characteristics of the elderly compared with the less-old group were: no differences in gender; higher ultimately fatal and fatal underlying disease (8.2% vs 4.4%, P < 0.02 and 18.3% vs 14.4%, P < 0.02, respectively); higher APACHE II score (15.95 ± 6.35 vs 12.08 ± 6.7, P < 0.001); more frequent infection disease at admission (33.1% vs 24.9%, P < 0.01) and sepsis (19.0% vs 13%, P < 0.02). During the ICU stay there were a higher use of inotropic agents (36.9% vs 29.6%, P < 0.03) and no significant differences in the use of sedation, dialysis, insulin, recombinant human activated protein C, surgery and nutritional therapy. There was no difference in SOFA score at ICU discharge between groups (1.58 ± 3.3 vs 1.49 ± 3.9, P < 0.74). More important bad outcomes were observed in the elderly group compared with less-old patients: higher mortality rate at ICU (15.7% vs 9.1%, P < 0.009); higher mechanical ventilation-days (3.97 ± 12.7 vs 2.45 ± 6.38, P < 0.001); higher nosocomial sepsis rates (12.4% vs 8.8%), but not significant (P < 0.108). The hospital stay after ICU discharge was higher in the elderly group (11.4 ± 17.3 vs 7.7 ± 11.7 days, P < 0.002), as well as hospital discharge rates being lower (69.2% vs 83.4%, P < 0.001). Age separately was not significant as a predictive factor of bad outcome (OR 1.8; 95% CI 1.19–2.90, P < 0.005) in univariate analysis.
Age separately was not predictive of bad outcomes. The sum of ICU therapeutic interventions was not discriminative for outcomes between elderly and less-old patients. Severity of illness and infection at admission were determinant of bad outcomes in the elderly patients.