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Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
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Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
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
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
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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).
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To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness.


A prospective cohort study was carried out.


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).


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).


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.

Hospital mortality
Critical illness
Activities of daily living

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


Estudio de cohorte prospectiva.


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).


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).


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:
Mortalidad hospitalaria
Enfermedad crítica
Actividades de la vida diaria


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