Somme Dominique, Maillet Jean-Michel, Gisselbrecht Mathilde, Novara Ana, Ract Catherine, Fagon Jean-Yves
Service de Gériatrie, Hôpital Européen Georges-Pompidou, 75908 , Paris Cedex 15, France.
Service de Réanimation Médicale, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 , Paris Cedex 15, France.
Intensive Care Med. 2003 Dec;29(12):2137-2143. doi: 10.1007/s00134-003-1929-2. Epub 2003 Nov 12.
The purpose of this study was to examine characteristics and outcome of the old, very old and oldest-old ICU patients DESIGN. This is a cohort study.
The study was set in a ten-bed medical ICU in a university hospital. PARTICIPANTS. There were 410 patients classified in three subgroups: old, 75-79 years ( n=184; 44.4%), very old, 80-84 ( n=137, 33.4%) and the oldest-old, >or=85 ( n=91; 22.2%).
Underlying medical conditions, organ dysfunction, severity of illness, length of stay, use of mechanical ventilation, therapeutic activity and nosocomial infections were recorded. Multivariate analysis was conducted to identify risk factors for ICU and long-term mortality.
Characteristics at ICU admission did not differ among the three groups. ICU length of stay, therapeutic activity, mechanical ventilation and nosocomial infection(s) decreased with age. ICU survival rates for those below 75, 75-79, 80-84 and over 85 years were 80, 68, 75 and 69%, respectively; survival rates at 3 months were 54, 56 and 51%, respectively. APACHE II score [odds ratio (OR): 1.11] was identified as the only factor associated with ICU mortality, and age (OR: 2.17, for patients >or=85 years old and 1.82, for patients 80-84 years old) and limitation of activity before admission (OR: 1.74) as factors associated with long-term mortality.
In a population of patients >or=75 years old, very old age is not directly associated with ICU mortality. After ICU discharge, deaths occurred predominantly during the first 3 months: age and prior limitation of activity were associated with the risk of dying.
本研究旨在调查老年、高龄和超高龄重症监护病房（ICU）患者的特征及预后。设计：这是一项队列研究。
研究在一所大学医院的一个拥有十张床位的内科ICU中进行。参与者：410名患者被分为三个亚组：老年组，75 - 79岁（n = 184；44.4%），高龄组，80 - 84岁（n = 137，33.4%）和超高龄组，≥85岁（n = 91；22.2%）。
记录基础疾病、器官功能障碍、疾病严重程度、住院时间、机械通气的使用、治疗活动及医院感染情况。进行多变量分析以确定ICU及长期死亡率的危险因素。
三组患者入住ICU时的特征无差异。ICU住院时间、治疗活动、机械通气及医院感染随年龄增长而减少。75岁以下、75 - 79岁、80 - 84岁及85岁以上患者的ICU生存率分别为80%、68%、75%和69%；3个月时的生存率分别为54%、56%和51%。急性生理与慢性健康状况评分系统（APACHE II）评分[比值比（OR）：1.11]被确定为与ICU死亡率相关的唯一因素，年龄（≥85岁患者的OR为2.17，80 - 84岁患者的OR为1.82）及入院前活动受限（OR：1.74）为与长期死亡率相关的因素。
在≥75岁的患者群体中，高龄并非直接与ICU死亡率相关。ICU出院后，死亡主要发生在最初3个月内：年龄及入院前活动受限与死亡风险相关。
