1. Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study
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Ibarz, Mercedes, Boumendil, Ariane, Haas, Lenneke E M, Irazabal, Marian, Flaatten, Hans, de Lange, Dylan W, Morandi, Alessandro, Andersen, Finn H, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Bollen Pinto, Bernardo, Soliman, Ivo W, Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Artigas, Antonio, Schmutz R, Wimmer F, Eller P, Joannidis M, De Buysscher P, De Neve N, Oeyen S, Swinnen W, Bollen Pinto B, Abraham P, Hergafi L, Schefold JC, Biskup E, Piza P, Taliadoros I, Fjølner J, Dey N, Sølling C, Rasmussen BS, Christensen S, Forceville X, Besch G, Mentec H, Michel P, Mateu P, Vettoretti L, Bourenne J, Marin N, Guillot M, Aissaoui N, Goulenok C, Thieulot-Rolin N, Messika J, Lamhaut L, Guidet B, Charron C, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Nia AM, Jung C, Janosi RA, Meybohm P, Simon P, Utzolino S, Rahmel T, Barth E, Schuster M, Aidoni Z, Aloizos S, Tasioudis P, Lampiri K, Zisopoulou V, Ravani I, Pagaki E, Antoniou A, Katsoulas TA, Kounougeri A, Marinakis G, Tsimpoukas F, Spyropoulou A, Zygoulis P, Kyparissi A, Gupta M, Gurjar M, Maji IM, Hayes I, Marsh B, Kelly Y, Westbrook A, Fitzpatrick G, Maheshwari D, Motherway C, Negri G, Spadaro S, Nattino G, Pedeferri M, Boscolo A, Rossi S, Calicchio G, Cubattoli L, Di Lascio G, Barbagallo M, Berruto F, Codazzi D, Bottazzi A, Fumagalli P, Negro G, Lupi G, Savelli F, Vulcano GA, Fumagalli R, Marudi A, Lefons U, Lembo R, Babini M, Paggioro A, Parrini V, Zaccaria M, Clementi S, Gigliuto C, Facondini F, Pastorini S, Munaron S, Calamai I, Bocchi A, Adorni A, Bocci MG, Cortegiani A, Casalicchio T, Melia S, Graziani E, Barattini M, Brizio E, Rossi M, Hahn M, Flattens H, Kemmerer N, Streiter HF, Dybwik K, Legernaes T, Klepstad P, Olaussen EB, Olsen KI, Brresen OM, Bjorsvik G, Andersen FH, Maini S, Fehrle L, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Kotfis K, Cwyl K, Gajdosz R, Biernawska J, Bohatyrewicz R, Gawda R, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Żukowski M, Bernas S, Piechota M, Szczeklik W, Nowak-Kózka I, Fronczek J, Serwa M, Machała W, Stefaniak J, Wujtewicz M, Szymkowiak M, Adamik B, Polok K, Włudarczyk A, Górka J, Kozera N, Goździk W, Catorze N, Branco MC, Barros I, Barros N, Krystopchuk A, Honrado T, Sousa C, Munoz F, Rebelo M, Gomes R, Nunes J, Dias C, Fernandes AM, Petrisor C, Constantin B, Belskiy V, Boskholov B, Rodriguez E, Rebollo S, Aguilar G, Masdeu G, Jaimes MI, Mira ÁP, Bodi MA, Barea Mendoza JA, López-Cuenca S, Guzman MH, Rico-Feijoo J, Ibarz M, Alvarez JT, Kawati R, Sivik J, Nauska J, Smole D, Parenmark F, Lyrén J, Rockstrohm K, Rydén S, Spångfors M, Strinnholm M, Walther S, De Geer L, Nordlund P, Pålsson S, Zetterquist H, Nilsson A, Thiringer K, Jungner M, Bark B, Nordling B, Sköld H, Brorsson C, Persson S, Bergström A, Berkius J, Holmström J, van Dijk I, Haas LEM, Ramnarain D, Jansen T, Nooteboom F, van der Voort PHJ, de Lange D, Dieperink W, de Waard MC, de Smet AGE, Bormans L, Dormans T, Dempsey G, Mathew SJ, Raj AS, Grecu I, Cupitt J, Lawton T, Clark R, Popescu M, Spittle N, Faulkner M, Cowton A, Elloway E, Williams P, Reay M, Chukkambotla S, Kumar R, Al-Subaie N, Kent L, Tamm T, Kajtor I, Burns K, Pugh R, Ostermann M, Kam E, Bowyer H, Smith N, Templeton M, Henning J, Goffin K, Kapoor R, Laha S, Chilton P, Khaliq W, Crayford A, Coetzee S, Tait M, Stoker W, Gimenez M, Pope A, Camsooksai J, Pogson D, Quigley K, Ritzema J, Hormis A, Boulanger C, Balasubramaniam M, Vamplew L, Burt K, Martin D, Craig J, Prowle J, Doyle N, Shelton J, Scott C, Donnison P, Shelton S, Frey C, Ryan C, Spray D, Barnes V, Barnes K, Ridgway S, Saha R, Clark T, Wood J, Bolger C, Bassford C, Lewandowski J, Zhao X, Humphreys S, Dowling S, Richardson N, Burtenshaw A, Stevenson C, Wilcock D, Nalapko Y., Ibarz, M, Boumendil, A, Haas, L, Irazabal, M, Flaatten, H, de Lange, D, Morandi, A, Andersen, F, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Bollen Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Artigas, A, Schmutz, R, Wimmer, F, Eller, P, Joannidis, M, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Schefold, J, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ravani, I, Pagaki, E, Antoniou, A, Katsoulas, T, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Melia, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Flattens, H, Kemmerer, N, Streiter, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Fronczek, J, Serwa, M, Stefaniak, J, Wujtewicz, M, Szymkowiak, M, Adamik, B, Polok, K, Wludarczyk, A, Gorka, J, Kozera, N, Gozdzik, W, Catorze, N, Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Parenmark, F, Lyren, J, Rockstrohm, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Nalapko, Y, Ibarz, Mercede, Boumendil, Ariane, Haas, Lenneke E M, Irazabal, Marian, Flaatten, Han, de Lange, Dylan W, Morandi, Alessandro, Andersen, Finn H, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Bollen Pinto, Bernardo, Soliman, Ivo W, Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zaferidis, Tilemacho, Guidet, Bertrand, Artigas, Antonio, Schmutz R, Wimmer F, Eller P, Joannidis M, De Buysscher P, De Neve N, Oeyen S, Swinnen W, Bollen Pinto B, Abraham P, Hergafi L, Schefold JC, Biskup E, Piza P, Taliadoros I, Fjølner J, Dey N, Sølling C, Rasmussen BS, Christensen S, Forceville X, Besch G, Mentec H, Michel P, Mateu P, Michel P, Vettoretti L, Bourenne J, Marin N, Guillot M, Aissaoui N, Goulenok C, Thieulot-Rolin N, Messika J, Lamhaut L, Guidet B, Charron C, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Nia AM, Jung C, Janosi RA, Meybohm P, Simon P, Utzolino S, Rahmel T, Barth E, Jung C, Schuster M, Aidoni Z, Aloizos S, Tasioudis P, Lampiri K, Zisopoulou V, Ravani I, Pagaki E, Antoniou A, Katsoulas TA, Kounougeri A, Marinakis G, Tsimpoukas F, Spyropoulou A, Zygoulis P, Kyparissi A, Gupta M, Gurjar M, Maji IM, Hayes I, Marsh B, Kelly Y, Westbrook A, Fitzpatrick G, Maheshwari D, Motherway C, Negri G, Spadaro S, Nattino G, Pedeferri M, Boscolo A, Rossi S, Calicchio G, Cubattoli L, Di Lascio G, Barbagallo M, Berruto F, Codazzi D, Bottazzi A, Fumagalli P, Negro G, Lupi G, Savelli F, Vulcano GA, Fumagalli R, Marudi A, Lefons U, Lembo R, Babini M, Paggioro A, Parrini V, Zaccaria M, Clementi S, Gigliuto C, Facondini F, Pastorini S, Munaron S, Calamai I, Bocchi A, Adorni A, Bocci MG, Cortegiani A, Casalicchio T, Melia S, Graziani E, Barattini M, Brizio E, Rossi M, Hahn M, Flattens H, Kemmerer N, Streiter HF, Dybwik K, Legernaes T, Klepstad P, Olaussen EB, Olsen KI, Brresen OM, Bjorsvik G, Andersen FH, Maini S, Fehrle L, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Kotfis K, Cwyl K, Gajdosz R, Biernawska J, Bohatyrewicz R, Gawda R, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Żukowski M, Bernas S, Piechota M, Szczeklik W, Nowak-Kózka I, Fronczek J, Serwa M, Machała W, Stefaniak J, Wujtewicz M, Szymkowiak M, Adamik B, Polok K, Włudarczyk A, Górka J, Kozera N, Goździk W, Catorze N, Branco MC, Barros I, Barros N, Krystopchuk A, Honrado T, Sousa C, Munoz F, Rebelo M, Gomes R, Nunes J, Dias C, Fernandes AM, Petrisor C, Constantin B, Belskiy V, Boskholov B, Rodriguez E, Rebollo S, Aguilar G, Masdeu G, Jaimes MI, Mira ÁP, Bodi MA, Barea Mendoza JA, López-Cuenca S, Guzman MH, Rico-Feijoo J, Ibarz M, Alvarez JT, Kawati R, Sivik J, Nauska J, Smole D, Parenmark F, Lyrén J, Rockstrohm K, Rydén S, Spångfors M, Strinnholm M, Walther S, De Geer L, Nordlund P, Pålsson S, Zetterquist H, Nilsson A, Thiringer K, Jungner M, Bark B, Nordling B, Sköld H, Brorsson C, Persson S, Bergström A, Berkius J, Holmström J, van Dijk I, Haas LEM, Ramnarain D, Jansen T, Nooteboom F, van der Voort PHJ, de Lange D, Dieperink W, de Waard MC, de Smet AGE, Bormans L, Dormans T, Dempsey G, Mathew SJ, Raj AS, Grecu I, Cupitt J, Lawton T, Clark R, Popescu M, Spittle N, Faulkner M, Cowton A, Elloway E, Williams P, Reay M, Chukkambotla S, Kumar R, Al-Subaie N, Kent L, Tamm T, Kajtor I, Burns K, Pugh R, Ostermann M, Kam E, Bowyer H, Smith N, Templeton M, Henning J, Goffin K, Kapoor R, Laha S, Chilton P, Khaliq W, Crayford A, Coetzee S, Tait M, Stoker W, Gimenez M, Pope A, Camsooksai J, Pogson D, Quigley K, Ritzema J, Hormis A, Boulanger C, Balasubramaniam M, Vamplew L, Burt K, Martin D, Grecu I, Craig J, Prowle J, Doyle N, Shelton J, Scott C, Donnison P, Shelton S, Frey C, Ryan C, Spray D, Ryan C, Barnes V, Barnes K, Ridgway S, Saha R, Kent L, Clark T, Wood J, Bolger C, Bassford C, Cowton A, Lewandowski J, Zhao X, Humphreys S, Dowling S, Richardson N, Burtenshaw A, Stevenson C, Wilcock D, Nalapko Y., Critical Care, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
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INTENSIVE-CARE-UNIT ,Survival ,HSJ UCI ,Critical Care and Intensive Care Medicine ,survival analysis ,law.invention ,sepsis ,Severity of illne ,0302 clinical medicine ,LONG-TERM OUTCOMES ,overlevingsanalyse ,law ,Medicine and Health Sciences ,EPIDEMIOLOGY ,Intensive care ,Mortality ,Outcome ,Sepsis ,Severity of illness ,Very old ,030212 general & internal medicine ,Prospective cohort study ,ELDERLY-PATIENTS ,ddc:617 ,PATIENTS AGED 80 ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Very Old ,Intensive care unit ,SOFA score ,medicine.symptom ,CRITICALLY-ILL PATIENTS ,WITHDRAWAL ,hormones, hormone substitutes, and hormone antagonists ,medicine.medical_specialty ,Sepsi ,elderly patients ,NO ,03 medical and health sciences ,sterfte ,Internal medicine ,medicine ,FRAILTY ,business.industry ,Septic shock ,Research ,SEPTIC SHOCK ,Organ dysfunction ,Intensive Care ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,oudere patiënten ,medicine.disease ,business - Abstract
BackgroundThe number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.ResultsThis prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7,p p p p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15),p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17),p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1),p = 0.85].ConclusionsAfter adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
- Published
- 2020