Julien Demiselle1, Guillaume Duval2,3, Jean-François Hamel4, Anne Renault5, Laetitia Bodet-Contentin6, Laurent Martin-Lefèvre7, Dominique Vivier8, Daniel Villers9, Montaine Lefèvre10, René Robert11, Philippe Markowicz12, Sylvain Lavoué13, Anne Courte14, Eddy Lebas15, Stéphanie Chevalier16, Cédric Annweiler2,3,17, Nicolas Lerolle18. 1. Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France. 2. Department of Geriatric Medicine, Angers University Hospital, 4 rue du Larrey, 49933 cedex 9, Angers, France. 3. Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, 4 rue du Larrey, 49933 cedex 9, Angers, France. 4. Maison de la Recherche, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France. 5. Service de Réanimation Médicale, Centre Hospitalier Universitaire, Boulevard Tanguy Prigent, 29609, Brest, France. 6. Hôpital Bretonneau, Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire de Tours, 2 Bis Boulevard Tonnellé, 37044, Tours Cedex 09, France. 7. Service de Réanimation Polyvalente, Centre Hospitalier Départemental Vendée-Hôpital de La-Roche-sur-Yon, Les Oudairies, 85925, La-Roche-sur-Yon Cedex 09, France. 8. Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 09, France. 9. Hôtel-Dieu, Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 30 bd Jean Monnet, 44093, Nantes, France. 10. Centre Hospitalier Des Pays de Morlaix, Service de Réanimation Polyvalente, 15, Rue de Kersaint Gilly, BP 97237, 29672, Morlaix Cedex, France. 11. CHU de Poitiers, Service de Réanimation Médicale, 2, Rue de la Milétrie, CS 90577, 86021, Poitiers Cedex, France. 12. Centre Hospitalier de Cholet, Service de Réanimation Polyvalente, 1 Rue de Marengo, BP 507, 49325, Cholet Cedex, France. 13. Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Unité de Réanimation Médicale, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France. 14. Centre Hospitalier de Saint Brieuc, Service de Réanimation Polyvalente, 10, Rue Marcel Proust, BP 2367, 22027, Saint Brieux Cedex 01, France. 15. Centre Hospitalier Bretagne Atlantique, 20 Boulevard Général Maurice Guillaudot, BP 70555, 56017, Vannes Cedex, France. 16. Centre Hospitalier de Saint Malo, Service de Réanimation Polyvalente, 1, Rue de la Marne, 35403, Saint Malo Cedex, France. 17. Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada. 18. Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France. nicolas.lerolle@univ-angers.fr.
Abstract
BACKGROUND: Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. METHODS: We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. RESULTS: 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients' place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. CONCLUSIONS: The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171.
BACKGROUND: Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. METHODS: We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. RESULTS: 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients' place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. CONCLUSIONS: The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171.
Authors: Laura Pietiläinen; Johanna Hästbacka; Minna Bäcklund; Ilkka Parviainen; Ville Pettilä; Matti Reinikainen Journal: Intensive Care Med Date: 2018-07-02 Impact factor: 17.440
Authors: William Wilson; Prithvishree Ravindra; Udaykumar J Khasage; Jeffrey Pradeep Raj; Vinayak Jain; Bijoyini Bose; Sreenidhi Kosuri Journal: J Family Med Prim Care Date: 2021-11-05
Authors: Stefan Andrei; Liana Valeanu; Mihai Gabriel Stefan; Dan Longrois; Mihai Popescu; Gabriel Stefan; Cosmin Balan; Raed Arafat; Dan Corneci; Gabriela Droc; Serban-Ion Bubenek-Turconi Journal: J Clin Med Date: 2022-03-11 Impact factor: 4.241