Sim Yun Su, Jung Hyunyon, Shin Tae Rim, Kim Dong Gyu, Park Sang Myeon
division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Respir Care. 2015 Mar;60(3):347-55. doi: 10.4187/respcare.03155. Epub 2014 Nov 18.
We evaluated the clinical characteristics and factors associated with mortality in very elderly patients ≥ 90 y of age admitted to the ICU.
We evaluated age-specific rates of admission and mortality in 16,935 subjects ≥ 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects ≥ 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward.
The mortality rate of ICU subjects ≥ 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P = .006), poor nutrition (P = .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P = .002), and vasopressor treatment (P = .03) were independent predictive factors of mortality in subjects ≥ 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died.
The very elderly subjects (≥ 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.
我们评估了入住重症监护病房（ICU）的90岁及以上超高龄患者的临床特征及与死亡率相关的因素。
我们评估了16935名18岁及以上受试者的年龄特异性入院率和死亡率，并回顾性分析了2003年1月至2012年7月期间入住ICU的155名（0.92%）90岁及以上受试者的临床数据。临床死亡指数定义为与包括营养不良、不要复苏（DNR）医嘱、肺炎、慢性肾衰竭、癌症、机械通气、使用血管升压药以及从病房入院等临床风险因素相关的ICU死亡率。
90岁及以上ICU受试者的死亡率为32.3%。Cox回归风险模型显示，高血糖（P = 0.006）、营养不良（P = 0.001）、简化急性生理学评分II（SAPS II）高分（P < 0.001）、DNR医嘱（P = 0.002）以及血管升压药治疗（P = 0.03）是入住ICU的90岁及以上受试者死亡的独立预测因素。临床风险因素数量增加与死亡率逐步升高相关。所有具有5个以上风险因素的受试者均死亡。
与其他年龄段的受试者相比，入住ICU的超高龄受试者（≥ 90岁）死亡率更高。高SAPS II评分、营养状况差、高血糖、使用血管升压药以及DNR医嘱应被视为超高龄ICU患者死亡的重要预测因素。对于具有5个或更多风险因素的超高龄患者，应仔细考虑ICU治疗水平。
