Long term outcomes for elderly patients after emergency intensive care admission: A cohort study

PLoS One. 2020 Oct 29;15(10):e0241244. doi: 10.1371/journal.pone.0241244. eCollection 2020.

Abstract

Background: Elderly patients (≥ 80 years of age) surviving an episode of critical illness suffer long-term morbidity and risk of mortality. Identifying high risk groups could assist in informing discussions with patients and families.

Aim: To determine factors associated with long-term survival following ICU admission.

Design: A cohort study of patients aged ≥ 80 years of age admitted to the ICU as an emergency.

Methods: Patients admitted from January 2010 to December 2018 were included in the study. Primary outcome was five year survival. Mortality was assessed using a multivariable flexible parametric survival analysis adjusted for demographics, and clinically relevant covariates.

Results: There were 828 patients. Mean age was 84 years (SD 3.2) and 419 (51%) were male. Patients were categorised into medical (423 (51%)) and surgical (405 (49%)) admissions. Adjusted hazard ratios (aHR) for mortality were highest for serum lactate (>8 mmol/l aHR 2.56 (C.I. 1.79-3.67)), lowest systolic blood pressure (< 70 mmHg aHR 2.04 (C.I. 1.36-3.05)) and pH (< 7.05 aHR 4.70 (C.I 2.67-8.21)). There were no survivors beyond one year with severe abnormalities of pH and lactate (< 7.05 and > 8 mmol/l respectively). Relative survival for medical patients was below that expected for the general population for the duration of the study.

Conclusion: Overall five-year survival was 27%. For medical and surgical patients it was 19% and 35% respectively. Survival at 30 days and one year was 61% and 46%. The presence of features of circulatory shock predicted poor short and long term survival.

MeSH terms

  • Aged, 80 and over
  • Critical Care*
  • Disease-Free Survival
  • Emergency Medical Services*
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Patient Admission*
  • Survival Rate

Grant support

The authors received no specific funding for this work.