Publish in this journal
Journal Information
Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
Share
Share
Download PDF
More article options
ePub
Visits
0
Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
Original
DOI: 10.1016/j.medine.2018.08.001
Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort
Factores de riesgo de mortalidad de los pacientes ancianos en cuidados intensivos sin limitación del esfuerzo de tratamiento
Visits
0
S.E. Giannasi, M.S. Venuti
Corresponding author
, A.D. Midley, N. Roux, C. Kecskes, E. San Román
Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
This item has received
0
Visits
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Tables (3)
Table 1. Baseline characteristics, cognitive function, performance status and quality of life before admission in the study cohort, and comparison between patients alive at discharge and patients who died during admission.
Table 2. Clinical outcomes during hospital admission.
Table 3. In-hospital mortality odds ratios (raw and adjusted).
Show moreShow less
Abstract
Outcome

To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness.

Design

A prospective cohort study was carried out.

Setting

A polyvalent intensive care unit at a University Hospital in Argentina.

Patients or participants

We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48h, between January 2011 and December 2012. Patients with degenerative neurological disease, limitation of therapeutic effort or on chronic mechanical ventilation were excluded.

Principal variables of interest

In-hospital mortality, comorbidity (Charlson index), APACHE II score, and pre-acute illness status were recorded: nutritional status (subjective global assessment), functionality (activities of daily living [ADL] and Barthel index), cognitive abilities (Short Reporting Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) and quality of life (EQ-5D).

Results

The in-hospital mortality rate was 52%. Logistic regression analysis, after adjusting for APACHE II score and age, identified the following independent variables associated to mortality: male gender (OR: 2.46, 95%CI: 1.37–4.42), moderate malnutrition (OR: 2.07, 95%CI: 1.09–3.94), severe malnutrition (OR: 2.20, 95%CI: 1.06–4.59), and ADL<6 (OR: 2.35, 95%CI: 1.16–4.75).

Conclusions

In our study, chronological age was not associated to in-hospital mortality. However, loss of functional independence (assessed by ADL) and malnourishment were shown to be strong prognostic factors; knowing these baseline characteristics from ICU admission would be useful when making decisions regarding the intensity of treatment.

Keywords:
Elderly
Hospital mortality
Critical illness
Activities of daily living
Resumen
Objetivo

Determinar factores pronóstico para mortalidad en los pacientes ancianos que se internan en unidades de cuidados intensivos (UCI) por enfermedad crítica aguda.

Diseño

Estudio de cohorte prospectiva.

Ámbito

Unidad de Terapia Intensiva polivalente en Hospital Universitario en Argentina.

Pacientes o participantes

Se incluyeron 249 pacientes mayores de 65años que ingresaron en forma consecutiva a la UCI con requerimiento de asistencia ventilatoria mecánica durante más de 48h entre enero de 2011 y diciembre de 2012. Fueron excluidos pacientes con enfermedad neurológica degenerativa, limitación de esfuerzos terapéuticos y ventilación mecánica crónica.

Variables de interés principales

Se registró la mortalidad hospitalaria, la carga de comorbilidad (índice de Charlson), APACHEII y estado previo a la enfermedad aguda: estado nutricional (valoración global subjetiva), funcionalidad (actividades de la vida diaria [AVD] o índice de Katz y Barthel), habilidades cognitivas (Short Informant Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) y calidad de vida (EQ-5D).

Resultados

La mortalidad hospitalaria fue del 52%. Por regresión logística, y después de ajustar por APACHEII y edad, resultaron variables independientes asociadas a mortalidad el sexo masculino, con un odds ratio (OR) de 2,46 (intervalo de confianza [IC] del 95%: 1,37–4,42), la desnutrición moderada (OR: 2,07, IC95%: 1,09–3,94), la desnutrición severa (OR: 2,20, IC95%: 1,06–4,59) y un AVD<6 (OR: 2,35, IC95%: 1,16–4,75).

Conclusiones

En nuestro estudio, la edad cronológica no resultó asociada a la mortalidad hospitalaria. Sin embargo, la pérdida de la independencia funcional (evaluada por AVD) y la desnutrición mostraron ser factores pronóstico. Conocer estos datos desde el ingreso por enfermedad crítica sería de utilidad a la hora de tomar decisiones relevantes respecto a la intensidad del tratamiento a instituir.

Palabras clave:
Anciano
Mortalidad hospitalaria
Enfermedad crítica
Actividades de la vida diaria

Article

These are the options to access the full texts of the publication Medicina Intensiva (English Edition)
Member
If you are a member of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias::
Go to the members area of the website of the SEMICYUC (www.semicyuc.org )and click the link to the magazine.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Medicina Intensiva (English Edition)

Contact
Telephone
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
902 88 87 40
Calls from outside Spain
+34 932 418 800
E-mail
Idiomas
Medicina Intensiva (English Edition)

Subscribe to our Newsletter

Article options
Tools
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?