Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study

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RESEARCH PRODUCT

Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study

Mercedes Ibarz Ariane Boumendil Lenneke E M Haas Marian Irazabal Hans Flaatten Dylan W De Lange Alessandro Morandi Finn H Andersen Guido Bertolini Maurizio Cecconi Steffen Christensen Loredana Faraldi Jesper Fjølner Christian Jung Brian Marsh Rui Moreno Sandra Oeyen Christina Agwald ÖHman Bernardo Bollen Pinto Ivo W Soliman Wojciech Szczeklik Andreas Valentin Ximena Watson Tilemachos Zaferidis Bertrand Guidet Antonio Artigas Schmutz R Wimmer F Eller P Joannidis M De Buysscher P De Neve N Oeyen S Swinnen W Bollen Pinto B Abraham P Hergafi L Schefold Jc Biskup E Piza P Taliadoros I Fjølner J Dey N Sølling C Rasmussen Bs Christensen S Forceville X Besch G Mentec H Michel P Mateu P Michel P Vettoretti L Bourenne J Marin N Guillot M Aissaoui N Goulenok C Thieulot-rolin N Messika J Lamhaut L Guidet B Charron C Lauten A Sacher Al Brenner T Franz M Bloos F Ebelt H Schaller Sj Fuest K Rabe C Dieck T Steiner S Graf T Nia Am Jung C Janosi Ra Meybohm P Simon P Utzolino S Rahmel T Barth E Jung C Schuster M Aidoni Z Aloizos S Tasioudis P Lampiri K Zisopoulou V Ravani I Pagaki E Antoniou A Katsoulas Ta Kounougeri A Marinakis G Tsimpoukas F Spyropoulou A Zygoulis P Kyparissi A Gupta M Gurjar M Maji Im Hayes I Marsh B Kelly Y Westbrook A Fitzpatrick G Maheshwari D Motherway C Negri G Spadaro S Nattino G Pedeferri M Boscolo A Rossi S Calicchio G Cubattoli L Di Lascio G Barbagallo M Berruto F Codazzi D Bottazzi A Fumagalli P Negro G Lupi G Savelli F Vulcano Ga Fumagalli R Marudi A Lefons U Lembo R Babini M Paggioro A Parrini V Zaccaria M Clementi S Gigliuto C Facondini F Pastorini S Munaron S Calamai I Bocchi A Adorni A Bocci Mg Cortegiani A Casalicchio T Melia S Graziani E Barattini M Brizio E Rossi M Hahn M Flattens H Kemmerer N Streiter Hf Dybwik K Legernaes T Klepstad P Olaussen Eb Olsen Ki Brresen Om Bjorsvik G Andersen Fh Maini S Fehrle L Czuczwar M Krawczyk P Ziętkiewicz M Nowak ŁR Kotfis K Cwyl K Gajdosz R Biernawska J Bohatyrewicz R Gawda R Grudzień P Nasiłowski P Popek N Cyrankiewicz W Wawrzyniak K Wnuk M Maciejewski D Studzińska D ŻUkowski M Bernas S Piechota M Szczeklik W Nowak-kózka I Fronczek J Serwa M Machała W Stefaniak J Wujtewicz M Szymkowiak M Adamik B Polok K Włudarczyk A Górka J Kozera N Goździk W Catorze N Branco Mc Barros I Barros N Krystopchuk A Honrado T Sousa C Munoz F Rebelo M Gomes R Nunes J Dias C Fernandes Am Petrisor C Constantin B Belskiy V Boskholov B Rodriguez E Rebollo S Aguilar G Masdeu G Jaimes Mi Mira ÁP Bodi Ma Barea Mendoza Ja López-cuenca S Guzman Mh Rico-feijoo J Ibarz M Alvarez Jt Kawati R Sivik J Nauska J Smole D Parenmark F Lyrén J Rockstrohm K Rydén S Spångfors M Strinnholm M Walther S De Geer L Nordlund P Pålsson S Zetterquist H Nilsson A Thiringer K Jungner M Bark B Nordling B Sköld H Brorsson C Persson S Bergström A Berkius J Holmström J Van Dijk I Haas Lem Ramnarain D Jansen T Nooteboom F Van Der Voort Phj De Lange D Dieperink W De Waard Mc De Smet Age Bormans L Dormans T Dempsey G Mathew Sj Raj As Grecu I Cupitt J Lawton T.Clark R Popescu M Spittle N Faulkner M Cowton A Elloway E Williams P Reay M Chukkambotla S Kumar R Al-subaie N Kent L Tamm T Kajtor I Burns K Pugh R Ostermann M Kam E Bowyer H Smith N Templeton M Henning J Goffin K Kapoor R Laha S Chilton P Khaliq W Crayford A Coetzee S Tait M Stoker W Gimenez M Pope A Camsooksai J Pogson D Quigley K Ritzema J Hormis A Boulanger C Balasubramaniam M Vamplew L Burt K Martin D Grecu I Craig J Prowle J Doyle N Shelton J Scott C Donnison P Shelton S Frey C Ryan C Spray D Ryan C Barnes V Barnes K Ridgway S Saha R Kent L Clark T Wood J Bolger C Bassford C Cowton A Lewandowski J Zhao X Humphreys S Dowling S Richardson N Burtenshaw A Stevenson C Wilcock D Nalapko Y.

subject

INTENSIVE-CARE-UNIT Survival HSJ UCI Critical Care and Intensive Care Medicine survival analysis law.invention sepsis Severity of illne 0302 clinical medicine LONG-TERM OUTCOMES overlevingsanalyse law Medicine and Health Sciences EPIDEMIOLOGY Intensive care; Mortality; Outcome; Sepsis; Severity of illness; Survival; Very old 030212 general & internal medicine Prospective cohort study ELDERLY-PATIENTS Outcome ddc:617 PATIENTS AGED 80 lcsh:Medical emergencies. Critical care. Intensive care. First aid Very Old Intensive care unit SOFA score medicine.symptom CRITICALLY-ILL PATIENTS WITHDRAWAL hormones hormone substitutes and hormone antagonists medicine.medical_specialty Sepsi Very old elderly patients Severity of illness NO Sepsis 03 medical and health sciences sterfte Sepsis Internal medicine Intensive care Severity of illness medicine Mortality FRAILTY business.industry Septic shock Research SEPTIC SHOCK Organ dysfunction Intensive Care 030208 emergency & critical care medicine lcsh:RC86-88.9 oudere patiënten medicine.disease Intensive care business

description

AbstractBackgroundThe number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.ResultsThis prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7,p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%,p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%;p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%;p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15),p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17),p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1),p = 0.85].ConclusionsAfter adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

year	journal	country	edition	language
2020-05-13

10.1186/s13613-020-00672-w https://ruj.uj.edu.pl/xmlui/handle/item/257746