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  • Bruno, Raphael RomanoHeinrich Heine Univ Duesseldorf, Germany (author)

Management and outcomes in critically ill nonagenarian versus octogenarian patients

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-10-19
  • BMC,2021
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:liu-180911
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-180911URI
  • https://doi.org/10.1186/s12877-021-02476-4DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:147952739URI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Funding Agencies|Western Health region in Norway; Projekt DEAL
  • 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.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Wernly, BernhardParacelsus Med Univ, Austria; Karolinska Univ Hosp, Sweden (author)
  • Kelm, MalteHeinrich Heine Univ Duesseldorf, Germany; Cardiovasc Res Inst Dusseldorf, Germany (author)
  • Boumendil, ArianeSt Hop Paris, France (author)
  • Morandi, AlessandroDept Rehabil Hosp Ancelle Cremona, Italy; Geriatr Res Grp, Italy (author)
  • Andersen, Finn H.Alesund Hosp, Norway; NTNU, Norway (author)
  • Artigas, AntonioCIBERes Corporac Sanitaria Univ Parc Tau, Spain (author)
  • Finazzi, StefanoIst Ric Farmacol Mario Negri IRCCS, Italy (author)
  • Cecconi, MaurizioHumanitas Univ, Italy (author)
  • Christensen, SteffenAarhus Univ Hosp, Denmark (author)
  • Faraldi, LoredanaGrande Osped Metropolitano Niguarda, Italy (author)
  • Lichtenauer, MichaelParacelsus Med Univ, Austria (author)
  • Muessig, Johanna M.Heinrich Heine Univ Duesseldorf, Germany (author)
  • Marsh, BrianMater Misericordiae Univ Hosp, Ireland (author)
  • Moreno, RuiUniv Lisboa Cent, Portugal (author)
  • Oeyen, Sandra1K12 Ghent Univ Hosp, Belgium (author)
  • ohman, Christina AgvaldKarolinska Univ Hosp, Sweden (author)
  • Pinto, Bernardo BollenGeneva Univ Hospitals, Switzerland (author)
  • Soliman, Ivo W.Univ Utrecht, Netherlands (author)
  • Szczeklik, WojciechJagiellonian Univ, Poland (author)
  • Valentin, AndreasKardinal Schwarzenberg Hosp, Austria (author)
  • Watson, XimenaSt Georges Univ Hosp, England (author)
  • Leaver, SusannahRes Lead Critical Care Directorate St Georges Hos, England (author)
  • Boulanger, CaroleRoyal Devon & Exeter NHS Fdn Trust, England (author)
  • Walther, StenRegion Östergötland, Thorax-kärlkliniken i Östergötland(Swepub:liu)stewa50 (author)
  • Schefold, Joerg C.Univ Bern, Switzerland (author)
  • Joannidis, MichaelMed Univ Innsbruck, Austria (author)
  • Nalapko, YuriyICU, Ukraine (author)
  • Elhadi, MuhammedAlkhums Hosp, Libya (author)
  • Fjolner, JesperAarhus Univ Hosp, Denmark (author)
  • Zafeiridis, TilemachosGen Hosp Larissa, Greece (author)
  • De Lange, Dylan W.Univ Utrecht, Netherlands (author)
  • Guidet, BertrandSt Hop Paris, France; Sorbonne Univ, France; INSERM, France (author)
  • Flaatten, HansUniv Bergen, Norway; Haukeland Hosp, Norway (author)
  • Jung, ChristianHeinrich Heine Univ Duesseldorf, Germany (author)
  • Heinrich Heine Univ Duesseldorf, GermanyParacelsus Med Univ, Austria; Karolinska Univ Hosp, Sweden (creator_code:org_t)

Related titles

  • In:BMC Geriatrics: BMC21:11471-2318

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