Lee Song-I, Koh Younsuck, Huh Jin Won, Hong Sang-Bum, Lim Chae-Man
Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acute Crit Care. 2022 Aug;37(3):372-381. doi: 10.4266/acc.2022.00066. Epub 2022 Aug 4.
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007-2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Comparing the first half (2007-2012) and the second half (2013-2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.
韩国正迅速步入超级老龄化社会，老年人群的重症监护负担日益加重。传统上，高龄一直被视为重症监护病房（ICU）收治的分诊标准。我们评估了过去十年间入住ICU的高龄患者（≥85岁）的特征和预后因素是如何变化的。
我们回顾性评估了11年（2007 - 2017年）间入住ICU的患者数据。对高龄患者组的临床特征和结局进行了评估。通过Cox回归分析评估与死亡率相关的因素。
比较研究期间的前半期（2007 - 2012年）和后半期（2013 - 2017年），高龄组的比例从603/47,657（1.3%）增至697/37,756（1.8%）（P<0.001）。在1,294例高龄患者中，排除无望出院的患者（n = 20）后，对1,274例患者进行了分析。因非手术原因入住ICU的比例（67.0%对76.1%，P<0.001）以及合并症患者的百分比（78.3%对82.7%，P = 0.048）均有所增加。然而，医院死亡率有所下降（21.3%对14.9%，P = 0.001）。高肌酐水平、使用血管升压药和脱机失败与住院死亡率相关。
过去十年间，ICU中高龄人群的比例有所增加。与手术原因相比，因非手术原因入住ICU的情况有所增加。尽管高龄患者入住ICU的人数有所增加，但高龄ICU患者的住院死亡率却有所下降。
