Management and outcomes in critically ill nonagenarian versus octogenarian patients

Raphael Romano Bruno, Bernhard Wernly, on behalf of the VIP2 study group, Malte Kelm, Ariane Boumendil, Alessandro Morandi, Finn H. Andersen, Antonio Artigas, Stefano Finazzi, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Michael Lichtenauer, Johanna M. Muessig, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agvald Öhman, Bernardo Bollen Pinto, Ivo W. SolimanWojciech Szczeklik, Andreas Valentin, Ximena Watson, Susannah Leaver, Carole Boulanger, Sten Walther, Joerg C. Schefold, Michael Joannidis, Yuriy Nalapko, Muhammed Elhadi, Jesper Fjølner, Tilemachos Zafeiridis, Dylan W. De Lange, Bertrand Guidet, Hans Flaatten, Christian Jung*

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Article number576
JournalBMC Geriatrics
Volume21
Issue number1
DOIs
Publication statusPublished - 19 Oct 2021

Bibliographical note

Funding Information:
This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Financial support for creation of the e-CRF and maintenance of the database was possible from a grant (open project support) by Western Health region in Norway) 2018 who also funded the participating Norwegian ICUs. DRC Ile de France and URC Est helped conducting VIP2 in France. Open Access funding enabled and organized by Projekt DEAL.

Publisher Copyright: © 2021, The Author(s).

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