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Determinants of hospital and one-year mortality among older patients admitted to intensive care units: results from the multicentric SENIOREA cohort

Authors :
Julien Demiselle
Guillaume Duval
Jean-François Hamel
Anne Renault
Laetitia Bodet-Contentin
Laurent Martin-Lefèvre
Dominique Vivier
Daniel Villers
Montaine Lefèvre
René Robert
Philippe Markowicz
Sylvain Lavoué
Anne Courte
Eddy Lebas
Stéphanie Chevalier
Cédric Annweiler
Nicolas Lerolle
Source :
Annals of Intensive Care, Vol 11, Iss 1, Pp 1-12 (2021)
Publication Year :
2021
Publisher :
SpringerOpen, 2021.

Abstract

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

Details

Language :
English
ISSN :
21105820
Volume :
11
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Annals of Intensive Care
Publication Type :
Academic Journal
Accession number :
edsdoj.7c45b6771ba64f08b5e1aa760f58436a
Document Type :
article
Full Text :
https://doi.org/10.1186/s13613-021-00804-w