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Pasieka P, Surówka A, Fronczek J, Skwara E, Czuczwar M, Borys M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Skowronek J, Solek-Pastuszka J, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Sierakowska K, Mudyna W, Białka S, Studzińska D, Bernas S, Piechota M, Machała W, Sadowski Ł, Stefaniak J, Owczuk R, Szymkowiak M, Gawda R, Kozera N, Adamik B, Goździk W, Wieczorek A, Janc J, Kluzik A, Trzebicki J, Zatorski P, Gola W, Hymczak H, Krzych LJ, Czajka S, Kościuczuk U, Kudliński B, Flaatten H, Szczeklik W. Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies. J Crit Care 2024; 79:154439. [PMID: 37832351 DOI: 10.1016/j.jcrc.2023.154439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
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Affiliation(s)
- Paweł Pasieka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Anna Surówka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Evan Skwara
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Michał Borys
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland
| | - Łukasz R Nowak
- Department of Intensive Care and Anaesthesiology, 5(th) Military Clinical Hospital in Kraków, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Center in Lubin, Poland
| | - Jacek Skowronek
- St. Raphael Hospital, Department of Anaesthesiology and Intensive Care, Kraków, Poland
| | - Joanna Solek-Pastuszka
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Paweł Grudzień
- Department of Anaesthesiology and Intensive Therapy, E. Szczeklik Specialist Hospital in Tarnów, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Kraków, Poland; Department of Anaesthesiology and Intensive Care, St Ann Hospital in Miechów, Poland
| | - Natalia Popek
- Department of Anaesthesiology and Intensive Therapy, S. Żeromski Specialist Hospital in Kraków, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialized Hospital in Kraków, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Anaesthesiology and Intensive Care, St John Grande Hospital in Kraków, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Małgorzata Szymkowiak
- Department of Anaesthesiology and Intensive Care, Provincial Hospital in Poznań, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wrocław Medical University, Wrocław, Poland
| | - Barbara Adamik
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Waldemar Goździk
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Agnieszka Wieczorek
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Jarosław Janc
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland; Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Trzebicki
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Paweł Zatorski
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1st Depratment of Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Lukasz J Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical Unibersity of Białystok, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Góra, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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Pasieka PM, Kurek M, Skupnik W, Skwara E, Bezshapkin V, Fronczek J, Kluzik A, Kudliński B, Białka S, Studzińska D, Krzych ŁJ, Czajka S, Stefaniak J, Owczuk R, Sołek-Pastuszka J, Biernawska J, Zorska J, Krawczyk P, Cwyl K, Żukowski M, Kotfis K, Zegan-Barańska M, Wieczorek A, Mudyna W, Piechota M, Bernas S, Machała W, Sadowski Ł, Serwa M, Czuczwar M, Borys M, Ziętkiewicz M, Kozera N, Adamik B, Goździk W, Nasiłowski P, Zatorski P, Trzebicki J, Gałkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Sierakowska K, Gola W, Hymczak H, Flaatten H, Szczeklik W. Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study. Anaesthesiol Intensive Ther 2024; 56:61-69. [PMID: 38741445 PMCID: PMC11022638 DOI: 10.5114/ait.2024.138192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/24/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.
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Affiliation(s)
- Paweł Melchior Pasieka
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Kurek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Skupnik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Evan Skwara
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Valentyn Bezshapkin
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Gora, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. John Grande Hospital in Krakow, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Joanna Sołek-Pastuszka
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Joanna Zorska
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Centre in Lublin, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | | | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialist Hospital in Krakow, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Marta Serwa
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Mirosław Czuczwar
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Michał Borys
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
- 2 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Goździk
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. Ann Hospital in Miechow, Poland
| | - Paweł Zatorski
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Janusz Trzebicki
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Piotr Gałkin
- Department of Anaesthesiology and Intensive Care, Regional Hospital in Bialystok, Poland
| | - Ryszard Gawda
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
- Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Fronczek J, Polok KJ, Nowak-Kózka I, Włudarczyk A, Górka J, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Gajdosz R, Bohatyrewicz R, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Bernas S, Piechota M, Machała W, Serwa M, Wujtewicz M, Stefaniak J, Szymkowiak M, Gawda R, Adamik B, Kozera N, Goździk W, Flaatten H, Szczeklik W. Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs. Anaesthesiol Intensive Ther 2018; 50:245-251. [PMID: 30242826 DOI: 10.5603/ait.a2018.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. METHODS This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9). RESULTS We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01). CONCLUSION Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland.
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