Pintado María-Consuelo, Villa Patricia, González-García Natalia, Luján Jimena, Molina Rocío, Trascasa María, López-Ramos Esther, Martínez Cristina, Cambronero José-Andrés, de Pablo Raúl
Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco, s/n, Alcalá de Henares, 28805 Madrid, Spain.
Palliative Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain.
ScientificWorldJournal. 2013 Dec 25;2013:590837. doi: 10.1155/2013/590837. eCollection 2013.
There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome.
Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission/refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality.
338 elderly patients were evaluated for ICU admission and 88 were refused to ICU (26%). Patients refused because they were "too ill to benefit" had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients "too ill to benefit" (55.6% versus 35.8%, P < 0.01), which also have higher 1-year mortality (73.7% versus 42.5%, P < 0.01). High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis.
Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years.
关于决定哪些老年患者被拒绝入住重症监护病房（ICU）的过程、他们的特征及结局的数据较少。
前瞻性纵向观察队列研究。我们纳入了所有连续的75岁以上患者，这些患者在18个月期间接受了ICU入院评估但被拒绝治疗，并进行了12个月的随访。我们收集了人口统计学数据、ICU入院/拒绝原因、既往功能和认知状态、合并症、疾病严重程度以及医院和12个月死亡率。
338名老年患者接受了ICU入院评估，88名被拒绝入住ICU（26%）。因“病情过重无法获益”而被拒绝的患者比入住ICU的患者合并症更多，功能和精神状况更差；疾病严重程度无差异。整个研究队列的医院死亡率为36.3%，“病情过重无法获益”的患者更高（55.6%对35.8%，P<0.01），其1年死亡率也更高（73.7%对42.5%，P<0.01）。多因素分析显示，高合并症、低功能状态、无可用ICU床位和年龄与拒绝决定相关。
既往功能状态和合并症，而非仅年龄或疾病严重程度，能更有助于我们对75岁以上患者做出入住或拒绝入住ICU的正确决策。
