Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Clin J Am Soc Nephrol. 2011 Mar;6(3):613-9. doi: 10.2215/CJN.01160210. Epub 2010 Dec 2.
Elderly patients (> 65 years old) are a rapidly growing demographic in the ESRD and intensive care unit (ICU) populations, yet the effect of ESRD status on critical illness in elderly patients remains unknown. Reliable estimates of prognosis would help to inform care and management of this frail and vulnerable population.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The effect of ESRD status on survival and readmission rates was examined in a retrospective cohort of 14,650 elderly patients (>65 years old) admitted to 11 ICUs in Winnipeg, Manitoba, Canada between 2000 and 2006. Logistic regression models were used to adjust odds of mortality and readmission to ICU for baseline case mix and illness severity.
Elderly ESRD patients had twofold higher crude in-hospital mortality (22% versus 13%, P < 0.0001) and readmission rate (6.4 versus 2.7%, P = 0.001). After adjustment for illness severity alone or illness severity and case mix, the odds ratio for mortality decreased to 0.85 (95% CI: 0.57 to 1.25) and 0.82 (95% CI: 0.55 to 1.23), respectively. In contrast, ESRD status remained significantly associated with readmission to ICU after adjustment for other risk factors (OR 2.06 [95% CI: 1.32, 3.22]).
Illness severity on admission, rather than ESRD status per se, appears to be the main driver of in-hospital mortality in elderly patients. However, ESRD status is an independent risk factor for early and late readmission, suggesting that this population might benefit from alternative strategies for ICU discharge.
老年患者（>65 岁）在终末期肾病（ESRD）和重症监护病房（ICU）人群中增长迅速，但 ESRD 状态对老年患者重症的影响尚不清楚。可靠的预后估计有助于为这一脆弱人群提供护理和管理。
设计、设置、参与者和测量：在一项回顾性队列研究中，对 2000 年至 2006 年间加拿大马尼托巴省温尼伯市 11 个 ICU 收治的 14650 名老年患者（>65 岁）的 ESRD 状态对生存率和再入院率的影响进行了研究。使用逻辑回归模型调整基线病例组合和疾病严重程度对死亡率和再入院 ICU 的几率。
老年 ESRD 患者的住院死亡率（22%比 13%，P<0.0001）和再入院率（6.4%比 2.7%，P=0.001）均高出两倍。仅调整疾病严重程度或疾病严重程度和病例组合后，死亡率的比值比降低至 0.85（95%CI：0.57 至 1.25）和 0.82（95%CI：0.55 至 1.23）。相比之下，在调整其他危险因素后，ESRD 状态仍与再入院 ICU 显著相关（OR 2.06[95%CI：1.32，3.22]）。
入院时的疾病严重程度，而不是 ESRD 状态本身，似乎是老年患者住院死亡率的主要驱动因素。然而，ESRD 状态是早期和晚期再入院的独立危险因素，这表明这一人群可能受益于 ICU 出院的替代策略。
