ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients w...
Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-07-01
|
Series: | Frontiers in Medicine |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.697884/full |
id |
doaj-91db84d13edb4cb8a136e0c5cc7f8551 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Raphael Romano Bruno Bernhard Wernly Bernhard Wernly Bernhard Wernly Behrooz Mamandipoor Richard Rezar Stephan Binnebössel Philipp Heinrich Baldia Georg Wolff Malte Kelm Bertrand Guidet Bertrand Guidet Bertrand Guidet Dylan W. De Lange Daniel Dankl Andreas Koköfer Thomas Danninger Wojciech Szczeklik Sviri Sigal Peter Vernon van Heerden Michael Beil Jesper Fjølner Susannah Leaver Hans Flaatten Venet Osmani Christian Jung |
spellingShingle |
Raphael Romano Bruno Bernhard Wernly Bernhard Wernly Bernhard Wernly Behrooz Mamandipoor Richard Rezar Stephan Binnebössel Philipp Heinrich Baldia Georg Wolff Malte Kelm Bertrand Guidet Bertrand Guidet Bertrand Guidet Dylan W. De Lange Daniel Dankl Andreas Koköfer Thomas Danninger Wojciech Szczeklik Sviri Sigal Peter Vernon van Heerden Michael Beil Jesper Fjølner Susannah Leaver Hans Flaatten Venet Osmani Christian Jung ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock Frontiers in Medicine sepsis intensive care critically ill obesity old very old |
author_facet |
Raphael Romano Bruno Bernhard Wernly Bernhard Wernly Bernhard Wernly Behrooz Mamandipoor Richard Rezar Stephan Binnebössel Philipp Heinrich Baldia Georg Wolff Malte Kelm Bertrand Guidet Bertrand Guidet Bertrand Guidet Dylan W. De Lange Daniel Dankl Andreas Koköfer Thomas Danninger Wojciech Szczeklik Sviri Sigal Peter Vernon van Heerden Michael Beil Jesper Fjølner Susannah Leaver Hans Flaatten Venet Osmani Christian Jung |
author_sort |
Raphael Romano Bruno |
title |
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock |
title_short |
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock |
title_full |
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock |
title_fullStr |
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock |
title_full_unstemmed |
ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock |
title_sort |
icu-mortality in old and very old patients suffering from sepsis and septic shock |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-07-01 |
description |
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible. |
topic |
sepsis intensive care critically ill obesity old very old |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2021.697884/full |
work_keys_str_mv |
AT raphaelromanobruno icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bernhardwernly icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bernhardwernly icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bernhardwernly icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT behroozmamandipoor icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT richardrezar icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT stephanbinnebossel icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT philippheinrichbaldia icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT georgwolff icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT maltekelm icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bertrandguidet icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bertrandguidet icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT bertrandguidet icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT dylanwdelange icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT danieldankl icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT andreaskokofer icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT thomasdanninger icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT wojciechszczeklik icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT svirisigal icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT petervernonvanheerden icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT michaelbeil icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT jesperfjølner icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT susannahleaver icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT hansflaatten icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT venetosmani icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock AT christianjung icumortalityinoldandveryoldpatientssufferingfromsepsisandsepticshock |
_version_ |
1721311421741924352 |
spelling |
doaj-91db84d13edb4cb8a136e0c5cc7f85512021-07-09T10:26:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-07-01810.3389/fmed.2021.697884697884ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic ShockRaphael Romano Bruno0Bernhard Wernly1Bernhard Wernly2Bernhard Wernly3Behrooz Mamandipoor4Richard Rezar5Stephan Binnebössel6Philipp Heinrich Baldia7Georg Wolff8Malte Kelm9Bertrand Guidet10Bertrand Guidet11Bertrand Guidet12Dylan W. De Lange13Daniel Dankl14Andreas Koköfer15Thomas Danninger16Wojciech Szczeklik17Sviri Sigal18Peter Vernon van Heerden19Michael Beil20Jesper Fjølner21Susannah Leaver22Hans Flaatten23Venet Osmani24Christian Jung25Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDepartment of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, AustriaCenter for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, AustriaFondazione Bruno Kessler Research Institute, Trento, ItalyCenter for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, AustriaDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyHôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, FranceSorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, FranceINSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, FranceDepartment of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, NetherlandsDepartment of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, AustriaDepartment of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria0Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland1Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel2General Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel1Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel3Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark4Research Lead Critical Care Directorate St George's Hospital, London, United Kingdom5Department of Intensive Care, Anesthesia and Surgical Services, Haukeland University Hospital Bergen, Bergen, NorwayFondazione Bruno Kessler Research Institute, Trento, ItalyDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, GermanyPurpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.https://www.frontiersin.org/articles/10.3389/fmed.2021.697884/fullsepsisintensive carecritically illobesityoldvery old |