Ariyo Kevin, Canestrini Sergio, David Anthony S, Ruck Keene Alex, Wolfrum Sebastian, Owen Gareth
Department of Psychological Medicine, King's College London, London, UK
Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
BMJ Open. 2021 Oct 11;11(10):e045086. doi: 10.1136/bmjopen-2020-045086.
The influence of age on intensive care unit (ICU) decision-making is complex, and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making, we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.
A systematic review and meta-analysis of cohort studies published between January 2000 and April 2020, of elderly patients admitted to ICUs.
We extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effect meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias and a qualitative synthesis of subscores.
We identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (n=2326 elderly survivors). Elderly survivors' QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d=0.35 (-0.53 and -0.16)). Elderly survivors' QoL was also significantly greater when measured slightly before ICU, compared with follow-up, with a small effect size (d=0.26 (-0.44 and -0.08)). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d=0.21 (-0.43 and 0.00)). Mortality rates and length of follow-up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.
The results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision -aking in elderly ICU patients.
CRD42020181181.
年龄对重症监护病房（ICU）决策的影响较为复杂，目前尚不清楚其依据是预期的主观还是客观患者预后。为回应近期对基于年龄的ICU决策的担忧，我们探讨了在2019冠状病毒病大流行之前ICU幸存者自我评估的生活质量（QoL）。
对2000年1月至2020年4月期间发表的关于入住ICU老年患者的队列研究进行系统评价和荟萃分析。
我们提取了关于自我报告的生活质量（EQ-5D综合评分）、人口统计学和临床变量的数据。然后，我们使用随机效应荟萃分析，将随访时的生活质量评分与入院前评分、年龄匹配的人群对照或年轻的ICU幸存者评分进行比较。我们进行了敏感性分析以研究异质性和偏倚，并对分项评分进行了定性综合分析。
我们识别出2536项研究，纳入22项进行定性综合分析，18项进行荟萃分析（n = 2326名老年幸存者）。老年幸存者的生活质量明显低于年轻的ICU幸存者，效应量为小到中等（d = 0.35（-0.53和-0.16））。与随访时相比，在ICU入院前稍早测量时，老年幸存者的生活质量也明显更高，效应量较小（d = 0.26（-0.44和-0.08））。最后，他们的生活质量也略低于年龄匹配的社区对照，效应量也较小（d = 0.21（-0.43和0.00））。死亡率和随访时间部分解释了异质性。生活质量下降似乎主要归因于身体健康，而非心理健康项目。
结果表明，年龄作为ICU资源分配决定因素的比例性应受到密切审查，主观生活质量结局应指导老年ICU患者以患者为中心的决策。
CRD42020181181。
