Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.
Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75013, Paris, France.
Intensive Care Med. 2018 Jul;44(7):1027-1038. doi: 10.1007/s00134-018-5196-7. Epub 2018 May 17.
To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.
This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.
LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.
The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.
ClinicalTrials.gov (ID: NTC03134807).
记录和分析在 ICU 收治的非常高龄患者群体中，是否停止或撤回生命支持治疗（LST）的决策。
本前瞻性研究纳入了来自 21 个欧洲国家的 309 个 ICU 中年龄≥80 岁的重症监护患者，进行了 30 天死亡率随访。
在 5021 名患者中，有 1356 名（27.2%）患者存在 LST 限制：15%的患者做出了保留治疗的决定，12.2%的患者做出了撤回治疗的决定（包括之前做出保留治疗决定的患者）。限制 LST 的患者年龄更大，身体更虚弱，病情更严重，且更多为非择期入院。与限制 LST 的患者相比，接受撤回 LST 的患者更多为男性，且 ICU 住院时间更长。在保留治疗组，ICU 死亡率和 30 天死亡率分别为 29.1%和 53.1%，而在撤回治疗组，ICU 死亡率和 30 天死亡率分别为 82.2%和 93.1%。与北欧国家相比，东欧和南欧国家限制 LST 的情况较少见。与限制 LST 相关的患者独立因素包括：急性 ICU 入院（OR 5.77，95%CI 4.32-7.7）、临床虚弱量表（CFS）评分（OR 2.08，95%CI 1.78-2.42）、年龄增加（每增加 5 岁，OR 为 1.22（95%CI 1.12-1.34））和 SOFA 评分（OR 每增加 1 分，OR 为 1.07（95%CI 1.05-1.09））。在 GDP 较高的国家，限制 LST 的频率更高，而在宗教国家则更低。
与启动 LST 限制最相关的重要患者变量包括急性入院、虚弱、年龄、入院时 SOFA 评分和国家。
ClinicalTrials.gov（注册号：NTC03134807）。
