Swagata Tripathy1, J C Mishra2, S C Dash3. 1. Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhubaneswar, India. Electronic address: tripathyswagata@gmail.com. 2. Department of Anaesthesia and Intensive Care, Kalinga Institute of Medical Sciences, Bhubaneswar, India. 3. Department of Nephrology, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Abstract
PURPOSE: To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status. METHODS: A prospective study of 109 patients (215 screened) admitted consecutively to the intensive care unit from 2011 to 2012. Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, Malnutrition Universal Screening Tool score, socioeconomic category, functional status, delirium, and length of stay were recorded. Telephonic assessment of outcome was done at 1 year. Appropriate statistical tests compared differences between subgroups. Multivariate analysis was performed on significant variables (P<.1) affecting mortality. RESULTS: At 12 months after discharge, 46.8% of patients (mean age, 76.5±9.6 years; APACHEII, 22.7±6.4; and intensive care unit stay, 7.8±3.4 days) had died. Risk factors for mortality at 12 months were APACHE II score (P<.001; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), severe malnutrition (P=.006; OR, 0.08; 95% CI, 0.01-0.48), and delirium (P=.03; OR, 0.32; 95% CI, 0.11-0.9). Risk factors for short-term mortality (at 28 days) were APACHE II score (P=.02; OR, 1.1 [1.0-1.2]) and premorbid functional status (P=.03; OR, 0.2 [0.1-0.8]). Kaplan-Meier survival analysis showed a significant association with malnutrition (log-rank test, P=.012) but not with socioeconomic category. Most (72%) of the survivors had a favorable functional status. CONCLUSIONS: Malnutrition, delirium, and APACHEII were risk factors for long-term mortality. Survivors had a good functional outcome. Appropriate quality of life tools for this population need to be developed.
PURPOSE: To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status. METHODS: A prospective study of 109 patients (215 screened) admitted consecutively to the intensive care unit from 2011 to 2012. Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, Malnutrition Universal Screening Tool score, socioeconomic category, functional status, delirium, and length of stay were recorded. Telephonic assessment of outcome was done at 1 year. Appropriate statistical tests compared differences between subgroups. Multivariate analysis was performed on significant variables (P<.1) affecting mortality. RESULTS: At 12 months after discharge, 46.8% of patients (mean age, 76.5±9.6 years; APACHEII, 22.7±6.4; and intensive care unit stay, 7.8±3.4 days) had died. Risk factors for mortality at 12 months were APACHE II score (P<.001; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), severe malnutrition (P=.006; OR, 0.08; 95% CI, 0.01-0.48), and delirium (P=.03; OR, 0.32; 95% CI, 0.11-0.9). Risk factors for short-term mortality (at 28 days) were APACHE II score (P=.02; OR, 1.1 [1.0-1.2]) and premorbid functional status (P=.03; OR, 0.2 [0.1-0.8]). Kaplan-Meier survival analysis showed a significant association with malnutrition (log-rank test, P=.012) but not with socioeconomic category. Most (72%) of the survivors had a favorable functional status. CONCLUSIONS:Malnutrition, delirium, and APACHEII were risk factors for long-term mortality. Survivors had a good functional outcome. Appropriate quality of life tools for this population need to be developed.
Authors: Selina M Parry; Catherine L Granger; Sue Berney; Jennifer Jones; Lisa Beach; Doa El-Ansary; René Koopman; Linda Denehy Journal: Intensive Care Med Date: 2015-02-05 Impact factor: 17.440