Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

IF 1.6 Q2 ANESTHESIOLOGY

Anaesthesiology intensive therapy Pub Date : 2024-01-01 DOI:10.5114/ait.2024.138192

Paweł Melchior Pasieka, Michał Kurek, Wojciech Skupnik, Evan Skwara, Valentyn Bezshapkin, Jakub Fronczek, Anna Kluzik, Bartosz Kudliński, Szymon Białka, Dorota Studzińska, Łukasz Krzych, Szymon Czajka, Jan Stefaniak, Radosław Owczuk, Joanna Sołek-Pastuszka, Jowita Biernawska, Joanna Zorska, Paweł Krawczyk, Katarzyna Cwyl, Maciej Żukowski, Katarzyna Kotfis, Małgorzata Zegan-Barańska, Agnieszka Wieczorek, Wojciech Mudyna, Mariusz Piechota, Szymon Bernas, Waldemar Machała, Łukasz Sadowski, Marta Serwa, Mirosław Czuczwar, Michał Borys, Mirosław Ziętkiewicz, Natalia Kozera, Barbara Adamik, Waldemar Goździk, Paweł Nasiłowski, Paweł Zatorski, Janusz Trzebicki, Piotr Gałkin, Ryszard Gawda, Urszula Kościuczuk, Waldemar Cyrankiewicz, Katarzyna Sierakowska, Wojciech Gola, Hubert Hymczak, Hans Flaatten, Wojciech Szczeklik

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Abstract

Introduction: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes.

Material and methods: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed.

Results: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities.

Conclusions: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

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波兰重症监护病房收治的≥80岁患者的预后因素--VIP2前瞻性观察研究的事后分析。

简介老年患者给重症监护病房（ICU）的临床医生带来了巨大挑战。在这项研究中，我们试图描述波兰重症监护室收治的 80 岁以上患者的特征，并确定临床特征与短期预后之间的关联：本研究是对 VIP2 欧洲前瞻性观察研究的波兰队列进行的一项事后分析，该研究在 6 个月的时间内招募了入住重症监护室的 80 岁以上患者。收集的数据包括临床特征、临床虚弱量表（CFS）、老年病量表、重症监护室内的干预措施和结果（30 天和重症监护室死亡率及住院时间）。对虚弱患者（CFS>4）与非虚弱患者、幸存者与非幸存者进行了单变量分析。以CFS、日常生活活动能力评分（ADL）和认知能力下降问卷IQCODE为预测因素，以ICU或30天死亡率为结果，建立了多变量模型：共有来自 27 个重症监护室的 371 名患者被纳入研究。与非体弱患者相比，体弱患者的 ICU 死亡率（58% vs. 44.45%，P = 0.03）和 30 天死亡率（65.61% vs. 54.14%，P = 0.01）明显更高。幸存者的 SOFA 评分、CFS、ADL 和 IQCODE 均明显低于非幸存者。在多变量分析中，CFS（OR 1.15，95% CI：1.00-1.34）和 SOFA 评分（OR 1.29，95% CI：1.19-1.41）被认为是 ICU 死亡率的重要预测因素；但是，CFS 并不是 30 天死亡率的预测因素（P = 0.07）。ADL、IQCODE、多重药物治疗或合并症均无统计学意义：我们发现 CFS 与重症监护病房死亡率之间存在正相关，这可能表明对重症监护病房的每位患者进行评分的价值。与其他欧洲国家相比，波兰 ICU 老年患者的死亡率较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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