Amado Filipe Sousa, Moura Ed Carlos Rey, Oliveira Caio Márcio Barros, Dibai-Filho Almir Vieira, Neto João Nogueira, da Cunha Leal Plínio
Postgraduate Program on Adult Health, Federal University of Maranhao, Sao Luis, MA, Brazil.
Department of Critical Care Medicine, São Domingos Hospital, São Luís, Brazil.
Sci Rep. 2025 Jul 1;15(1):20486. doi: 10.1038/s41598-025-05343-z.
Demographic transition has led to a progressive increase in the proportion of elderly and very elderly patients. This population shift implies a growing demand for health resources, including intensive care, despite the high mortality rates associated with this age group in ICUs. To determine the clinical characteristics and outcomes of a population of critically ill elderly patients (≥ 90 years) admitted to the ICU and to identify predictive factors associated with mortality. This retrospective observational study analyzed data from critically ill elderly patients (≥ 90 years) admitted to the Intensive Medicine Service of a tertiary hospital in São Luís, MA, between 2021 and 2022. Demographic, clinical, treatment, and outcome data were collected, and statistical analysis was used to determine independent predictors of mortality. Of the 3551 patients admitted, 269 (≥ 90 years old) were included. The majority were female (69.5%), with a high prevalence of comorbidities. The emergency department was the main origin of patient admission (87%). The most frequent diagnostic category upon ICU admission was infection/sepsis. The median duration of ICU stay was seven days, and the median hospital stay was 15 days. The hospital mortality rate was 27.5%, and the ICU mortality rate was 17.8%. The use of mechanical ventilation and dialysis on the first day in the ICU was independently associated with increased mortality. Critically ill elderly patients (≥ 90 years) have a high prevalence of comorbidities, and specific interventions, such as mechanical ventilation and dialysis on the first day of the ICU, are predictors of mortality. Compared with other case series, the observed mortality was not high, suggesting that chronological age alone should not be a criterion for limiting access to intensive care. Decisions regarding triage (i.e., identifying which older adults are most likely to benefit from ICU-level care) and treatment limitations are crucial in this population.
人口转变导致老年和高龄患者的比例逐渐增加。这种人口结构的变化意味着对包括重症监护在内的医疗资源的需求不断增长，尽管重症监护病房（ICU）中该年龄组的死亡率很高。旨在确定入住ICU的老年重症患者（≥90岁）的临床特征和结局，并确定与死亡率相关的预测因素。这项回顾性观察性研究分析了2021年至2022年期间入住马萨诸塞州圣路易斯一家三级医院重症医学科的老年重症患者（≥90岁）的数据。收集了人口统计学、临床、治疗和结局数据，并使用统计分析来确定死亡率的独立预测因素。在3551名入院患者中，269名（≥90岁）被纳入研究。大多数为女性（69.5%），合并症患病率很高。急诊科是患者入院的主要来源（87%）。入住ICU时最常见的诊断类别是感染/脓毒症。ICU住院时间中位数为7天，住院时间中位数为15天。医院死亡率为27.5%，ICU死亡率为17.8%。入住ICU第一天使用机械通气和透析与死亡率增加独立相关。老年重症患者（≥90岁）合并症患病率很高，而特定干预措施，如入住ICU第一天进行机械通气和透析，是死亡率的预测因素。与其他病例系列相比，观察到的死亡率并不高，这表明不应仅以实际年龄作为限制重症监护准入的标准。在这一人群中，关于分诊（即确定哪些老年人最有可能从ICU级护理中受益）和治疗限制的决策至关重要。
