Ibarz Mercedes, Boumendil Ariane, Haas Lenneke E M, Irazabal Marian, Flaatten Hans, de Lange Dylan W, Morandi Alessandro, Andersen Finn H, Bertolini Guido, Cecconi Maurizio, Christensen Steffen, Faraldi Loredana, Fjølner Jesper, Jung Christian, Marsh Brian, Moreno Rui, Oeyen Sandra, Öhman Christina Agwald, Bollen Pinto Bernardo, Soliman Ivo W, Szczeklik Wojciech, Valentin Andreas, Watson Ximena, Zaferidis Tilemachos, Guidet Bertrand, Artigas Antonio
Department of Intensive Care Medicine, Hospital Universitario Sagrat Cor, Viladomat 288, 08029, Barcelona, Spain.
Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris, France.
Ann Intensive Care. 2020 May 13;10(1):56. doi: 10.1186/s13613-020-00672-w.
The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.
This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85].
After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
80岁及以上重症监护患者（高龄重症监护患者；VIPs）的数量正在增加。VIPs的死亡率和发病率很高，入住重症监护病房（ICU）的益处经常受到质疑。近年来脓毒症发病率有所上升，确定其预后具有相当大的公共重要性。我们旨在确定因脓毒症入院的VIPs与因其他急性原因入院的患者是否有不同的预后，并确定30天生存的潜在预后因素。
这项前瞻性研究纳入了21个欧洲国家307个ICU中急性入院、序贯器官衰竭评估（SOFA）评分≥2分的VIPs。在3869例急性入院的VIPs中，493例（12.7%）[男性占53.8%，中位年龄83（81 - 86）岁]因脓毒症入院。脓毒症根据临床标准定义；疑似或证实的感染灶且SOFA评分≥2分。与因其他急性原因入院的VIPs相比，因脓毒症入院的VIPs更年轻，SOFA评分更高（9分对7分，p < 0.0001），需要更多血管活性药物[82.2%对55.1%，p < 0.0001]和肾脏替代治疗[17.4%对9.9%；p < 0.0001]，并且有更多维持生命治疗限制[37.3%对32.1%；p = 0.02]。两组的虚弱程度相似。两组未调整的30天生存率无显著差异。在调整年龄、性别、虚弱程度和SOFA评分后，脓毒症对30天生存率无影响[风险比（HR）0.99（95%置信区间0.86 - 1.15），p = 0.917]。ICU入院后前30天的逆概率加权（IPW）调整生存曲线在急性脓毒症和非脓毒症患者中相似[HR：1.00（95%置信区间0.87 - 1.17），p = 0.95]。还进行了配对分析，将脓毒症患者与两名年龄、性别、SOFA评分和虚弱程度相同的对照患者进行匹配。基于匹配对分层的Cox比例风险回归模型显示，两组的30天生存率相似[57.2%（95%置信区间52.7 - 60.7）对57.1%（95%置信区间53.7 - 60.1），p = 0.85]。
在这项对3869例VIPs的多国研究中，调整器官功能障碍后，入院时的脓毒症与30天生存率降低无独立相关性。年龄、虚弱程度和SOFA评分与生存率独立相关。
