Eva E Tejerina1, Gesly Gonçalves2, Karen Gómez-Mediavilla2, Carlos Jaramillo2, Jorge Jiménez2, Fernando Frutos-Vivar3, José Ángel Lorente3, Israel J Thuissard4, Cristina Andreu-Vázquez4. 1. Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain. evateje@gmail.com. 2. Hospital Universitario de Getafe, Madrid, Spain. 3. Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain. 4. Universidad Europea de Madrid, Madrid, Spain.
Abstract
PURPOSE: We studied the impact of age on survival and functional recovery in brain-injured patients. METHODS: We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3-6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes. RESULTS: We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3-6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73-7.74, p < 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95-7.08, p < 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70-11.28, p < 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34-6.42, p < 0.001]. CONCLUSION: Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
PURPOSE: We studied the impact of age on survival and functional recovery in brain-injured patients. METHODS: We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3-6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes. RESULTS: We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3-6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73-7.74, p < 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95-7.08, p < 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70-11.28, p < 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34-6.42, p < 0.001]. CONCLUSION: Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
Authors: Anne C Mosenthal; Robert F Lavery; Michael Addis; Sanjeev Kaul; Steven Ross; Robert Marburger; Edwin A Deitch; David H Livingston Journal: J Trauma Date: 2002-05
Authors: Eva E Tejerina; Paolo Pelosi; Chiara Robba; Oscar Peñuelas; Alfonso Muriel; Deisy Barrios; Fernando Frutos-Vivar; Konstantinos Raymondos; Bin Du; Arnaud W Thille; Fernando Ríos; Marco González; Lorenzo Del-Sorbo; Maria Del Carmen Marín; Bruno Valle Pinheiro; Marco Antonio Soares; Nicolas Nin; Salvatore M Maggiore; Andrew Bersten; Pravin Amin; Nahit Cakar; Gee Young Suh; Fekri Abroug; Manuel Jibaja; Dimitros Matamis; Amine Ali Zeggwagh; Yuda Sutherasan; Antonio Anzueto; Andrés Esteban Journal: Crit Care Med Date: 2021-07-01 Impact factor: 7.598