Geriatric Unit, Department of Internal Medicine Hospital Clínic of Barcelona, Villarroel, 170, Barcelona 08036, Spain.
Crit Care. 2011;15(2):R105. doi: 10.1186/cc10121. Epub 2011 Mar 28.
Long-term outcomes of elderly patients after medical ICU care are little known. The aim of the study was to evaluate functional status and quality of life of elderly patients 12 months after discharge from a medical ICU.
We prospectively studied 112/230 healthy elderly patients (≥ 65 years surviving at least 12 months after ICU discharge) with full functional autonomy without cognitive impairment prior to ICU entry. The main diagnoses at admission using the Acute Physiology and Chronic Health Evaluation III (APACHE III) classification diagnosis and length of ICU stay and ICU scores (APACHE II, Sepsis-related Organ Failure Assessment (SOFA) and OMEGA) at admission and discharge were collected. Comprehensive geriatric assessment included the presence of the main geriatric syndromes and the application of Lawton, Barthel, and Charlson Indexes and Informant Questionnaire on Cognitive Decline to evaluate functionality, comorbidity and cognitive status, respectively. The EuroQol-5D assessed quality of life. Data were collected at baseline, during ICU and ward stay and 3, 6 and 12 months after hospital discharge. Paired or unpaired T-tests compared differences between groups (continuous variables), whereas the chi-square and Fisher exact tests were used for comparing dichotomous variables. For variables significant (P ≤ 0.1) on univariate analysis, a forward multiple regression analysis was performed.
Only 48.9% of patients (mean age: 73.4 ± 5.5 years) were alive 12 months after discharge showing a significant decrease in functional autonomy (Lawton and Barthel Indexes) and quality of life (EuroQol-5D) compared to baseline status (P < 0.001, all). Multivariate analysis showed a higher Barthel Index and EQ-5D vas at hospital discharge to be associated factors of full functional recovery (P < 0.01, both). Thus, in patients with a Barthel Index ≥ 60 or EQ-5D vas ≥ 40 at discharge the hazard ratio for full functional recovery was 4.04 (95% CI: 1.58 to 10.33; P = 0.005) and 6.1 (95% CI: 1.9 to 19.9; P < 0.01), respectively. Geriatric syndromes increased after ICU stay and remained significantly increased during follow-up (P < 0.001).
The survival rate of elderly medical patients 12 months after discharge from the ICU is low (49%), although functional status and quality of life remained similar to baseline in most of the survivors. However, there was a two-fold increase in the prevalence of geriatric syndromes.
老年人在重症监护病房（ICU）接受治疗后的长期预后情况鲜为人知。本研究旨在评估老年人在离开 ICU 12 个月后的功能状态和生活质量。
我们前瞻性研究了 112/230 名健康的老年患者（≥65 岁，在 ICU 出院后至少存活 12 个月），这些患者在进入 ICU 前具有完全的功能自主性，且无认知障碍。主要诊断采用急性生理学和慢性健康评估 III（APACHE III）分类诊断，收集入院时的 ICU 住院时间和 ICU 评分（APACHE II、脓毒症相关器官衰竭评估（SOFA）和 OMEGA）以及出院时的 ICU 评分。综合老年评估包括主要老年综合征的存在以及 Lawton、Barthel 和 Charlson 指数的应用和认知减退知情者问卷，分别用于评估功能、合并症和认知状况。EuroQol-5D 评估生活质量。数据在基线时、在 ICU 和病房期间以及出院后 3、6 和 12 个月收集。配对或非配对 T 检验比较组间差异（连续变量），而卡方和 Fisher 确切检验用于比较二分类变量。对单变量分析中具有显著意义的变量（P ≤ 0.1），进行向前逐步回归分析。
只有 48.9%的患者（平均年龄：73.4 ± 5.5 岁）在出院后 12 个月存活，与基线状态相比，功能自主性（Lawton 和 Barthel 指数）和生活质量（EuroQol-5D）显著下降（P < 0.001，均）。多变量分析显示，出院时 Barthel 指数和 EQ-5D vas 较高与完全功能恢复相关（P < 0.01，均）。因此，出院时 Barthel 指数≥60 或 EQ-5D vas ≥40 的患者完全功能恢复的危险比为 4.04（95%CI：1.58 至 10.33；P = 0.005）和 6.1（95%CI：1.9 至 19.9；P < 0.01）。老年综合征在 ICU 后增加，并在随访期间持续显著增加（P < 0.001）。
老年 ICU 患者出院后 12 个月的生存率较低（49%），尽管大多数幸存者的功能状态和生活质量仍与基线相似。然而，老年综合征的患病率增加了两倍。
