Adult Intensive Care Unit, Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland.
Intensive Care Unit, Réseau Hospitalier Neuchâtelois (RHNE), Neuchâtel, Switzerland.
BMC Nephrol. 2021 Mar 19;22(1):101. doi: 10.1186/s12882-021-02302-4.
Renal replacement therapy (RRT) in critically ill patients is associated with high morbidity and mortality. The appropriateness of RRT initiation is sometimes questioned in elderly patients. Therefore, we sought to evaluate the long-term mortality, dialysis dependence and quality of life (QOL) of elderly patients who survived critical illness requiring RRT.
This is a monocentric observational study including all patients > 55 yo who received RRT for acute kidney injury in our intensive care unit (ICU) between January 2015 and April 2018. At the time of the study (May 2019), we assessed if they were still alive by cross referencing our hospital database and the Swiss national death registry. We sent survivors written information and, subsequently, contacted them over the phone. We obtained their consent for participation, asked about their dialytic status and performed an EQ-5D survey with visual analog scale (VAS). Results were stratified according to their age at the time of ICU admission (G1: "55-65 yo"; G2: "> 65-75 yo" and G3: "> 75 yo"). QOL in G3 patients were compared to G1 and G2 and to predicted values.
Among the 352 eligible patients, 171 died during the index hospital admission. After a median follow-up time of 32.7 months (IQR 19.8), a further 62 had died (median time to death for ICU survivors 5.0 (IQR 15.0) months. Hence, 119 (33.6%) patients were still alive at the time of the study. We successfully contacted 96 (80.7%) of them and 83 (69.7%) were included in the study (G1: 24, G2: 44 and G3: 15). Only 6 (7.2%) were RRT dependent. Patients in G3 had lower EQ-5D and VAS scores than those in G1 and G2 (p < 0.01). These scores were also significantly lower than predicted values (p < 0.05).
RRT patients have a very high in-hospital and post discharge mortality. Among survivors, RRT dependency was low. Irrespective of baseline values, patients > 75 yo who survived ICU had a lower QOL than younger patients. It was lower than predicted according to age and sex. The appropriateness of RRT initiation in elderly patients should be discussed according to their pre-existing QOL and frailty.
危重症患者的肾脏替代治疗（RRT）与高发病率和死亡率相关。在老年患者中，有时会质疑 RRT 开始的适当性。因此，我们试图评估在需要 RRT 的危重病中幸存下来的老年患者的长期死亡率、透析依赖性和生活质量（QOL）。
这是一项单中心观察性研究，纳入了 2015 年 1 月至 2018 年 4 月期间在我们的重症监护病房（ICU）接受 RRT 治疗急性肾损伤的所有年龄>55 岁的患者。在研究时（2019 年 5 月），我们通过交叉参考我们的医院数据库和瑞士国家死亡登记处来评估他们是否仍然存活。我们向幸存者发送了书面信息，随后通过电话与他们联系。我们获得了他们的参与同意，询问了他们的透析状况，并使用视觉模拟量表（VAS）进行了 EQ-5D 调查。结果根据他们 ICU 入院时的年龄进行分层（G1：“55-65 岁”；G2：“>65-75 岁”和 G3：“>75 岁”）。将 G3 患者的 QOL 与 G1 和 G2 以及预测值进行比较。
在 352 名符合条件的患者中，171 名在指数住院期间死亡。中位随访时间为 32.7 个月（IQR 19.8）后，又有 62 名死亡（ICU 幸存者的中位死亡时间为 5.0（IQR 15.0）个月）。因此，在研究时，119 名（33.6%）患者仍然存活。我们成功联系了 96 名（80.7%）患者，其中 83 名（69.7%）纳入研究（G1：24 名，G2：44 名，G3：15 名）。只有 6 名（7.2%）患者需要 RRT。G3 患者的 EQ-5D 和 VAS 评分低于 G1 和 G2（p<0.01）。这些评分也明显低于预测值（p<0.05）。
RRT 患者的院内和出院后死亡率非常高。在幸存者中，RRT 依赖性较低。无论基线值如何，在 ICU 存活下来的年龄>75 岁的患者的生活质量都低于年轻患者。根据年龄和性别，它低于预测值。在老年患者中，应根据其预先存在的生活质量和脆弱性来讨论 RRT 开始的适当性。
