Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd. CC-470, Boston, MA 02215, USA.
Intensive Care Med. 2012 Oct;38(10):1654-61. doi: 10.1007/s00134-012-2629-6. Epub 2012 Jul 14.
The effect of advanced age per se versus severity of chronic and acute diseases on the short- and long-term survival of older patients admitted to the intensive care unit (ICU) remains unclear.
Intensive care unit admissions to the surgical ICU and medical ICU of patients older than 65 years were analyzed. Patients were divided into three age groups: 65-74, 75-84, and 85 and above. The primary endpoints were 28-day and 1-year mortality.
The analysis focused on 7,265 patients above the age of 65, representing 45.7 % of the total ICU population. From the first to third age group there was increased prevalence of heart failure (25.9-40.3 %), cardiac arrhythmia (24.6-43.5 %), and valvular heart disease (7.5-15.8 %). There was reduced prevalence of diabetes complications (7.5-2.4 %), alcohol abuse (4.1-0.6 %), chronic obstructive pulmonary disease (COPD) (24.4-17.4 %), and liver failure (5.0-1.0 %). Logistic regression analysis adjusted for gender, sequential organ failure assessment, do not resuscitate, and Elixhauser score found that patients from the second and third age group had odds ratios of 1.38 [95 % confidence interval (CI) 1.19-1.59] and 1.53 (95 % CI 1.29-1.81) for 28-day mortality as compared with the first age group. Cox regression analysis for 1-year mortality in all populations and in 28-day survivors showed the same trend.
The proportion of elderly patients from the total ICU population is high. With advancing age, the proportion of various preexisting comorbidities and the primary reason for ICU admission change. Advanced age should be regarded as a significant independent risk factor for mortality, especially for ICU patients older than 75.
年龄增长本身与慢性和急性疾病的严重程度对入住重症监护病房（ICU）的老年患者短期和长期生存率的影响尚不清楚。
分析了 65 岁以上患者入住外科 ICU 和内科 ICU 的情况。患者被分为三组：65-74 岁、75-84 岁和 85 岁及以上。主要终点为 28 天和 1 年死亡率。
分析重点是 7265 名 65 岁以上的患者，占 ICU 总人数的 45.7%。从第一组到第三组，心力衰竭的患病率增加（25.9%-40.3%）、心律失常（24.6%-43.5%）和心脏瓣膜病（7.5%-15.8%）。糖尿病并发症的患病率降低（7.5%-2.4%）、酒精滥用（4.1%-0.6%）、慢性阻塞性肺疾病（COPD）（24.4%-17.4%）和肝功能衰竭（5.0%-1.0%）。经过性别、序贯器官衰竭评估、不复苏和 Elixhauser 评分的调整，Logistic 回归分析发现，与第一年龄组相比，第二和第三年龄组患者 28 天死亡率的比值比分别为 1.38（95%可信区间 1.19-1.59）和 1.53（95%可信区间 1.29-1.81）。对所有人群和 28 天存活者的 1 年死亡率进行 Cox 回归分析，也显示出同样的趋势。
老年患者在 ICU 总人群中的比例较高。随着年龄的增长，各种并存疾病的比例以及入住 ICU 的主要原因发生变化。年龄增长应被视为死亡率的一个重要独立危险因素，尤其是对于 75 岁以上的 ICU 患者。
