51. Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study
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Michel Ramakers, Jean-Jacques Parienti, Nicolas Terzi, Xavier Valette, Stéphanie Chevalier, Amélie Seguin, Cathy Gaillard, Pierre Charbonneau, Damien du Cheyron, Cédric Daubin, Fabrice Prevost, Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Cellule Promotion de la Recherche Clinique [CHU Caen] (CPRC), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Cognition, Mobilités, Temporalité (COMETE), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Immunologie [CHU Caen], and BMC, Ed.
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Male ,Health Status ,Dependency, Psychological ,MESH: Cognition ,MESH: Comorbidity ,Comorbidity ,older persons intensive care unit ,intensive care unit ,MESH: Length of Stay ,0302 clinical medicine ,MESH: Aged, 80 and over ,Cognition ,Quality of life ,MESH: Risk Factors ,Risk Factors ,Activities of Daily Living ,Medicine ,030212 general & internal medicine ,Prospective Studies ,Survivors ,Prospective cohort study ,MESH: Health Status ,MESH: Aged ,MESH: Survivors ,Aged, 80 and over ,education.field_of_study ,General Medicine ,MESH: Follow-Up Studies ,functional autonomy ,3. Good health ,Intensive Care Units ,MESH: Critical Illness ,lcsh:R858-859.7 ,SOFA score ,Female ,Cohort study ,MESH: Forecasting ,medicine.medical_specialty ,MESH: Dependency (Psychology) ,Critical Care ,Critical Illness ,Population ,lcsh:Computer applications to medicine. Medical informatics ,03 medical and health sciences ,Internal medicine ,Intensive care ,Humans ,MESH: Intensive Care ,Intensive care medicine ,education ,Aged ,MESH: Humans ,business.industry ,Research ,MESH: Activities of Daily Living ,Public Health, Environmental and Occupational Health ,MESH: Quality of Life ,030208 emergency & critical care medicine ,Odds ratio ,Length of Stay ,mortality ,MESH: Male ,MESH: Prospective Studies ,Nottingham Health Profile ,quality of life ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,older persons ,MESH: Intensive Care Units ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,MESH: Female ,Follow-Up Studies ,Forecasting - Abstract
Background The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors. Methods We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score. Results One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life. Conclusions In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.
- Published
- 2011
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