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Journal Articles BMC Geriatrics Year : 2021

Management and outcomes in critically ill nonagenarian versus octogenarian patients

1 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
2 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
3 Karolinska Institutet [Stockholm]
4 CHU Saint-Antoine [AP-HP]
5 the Handmaids of Charity Nursing Home / Casa di Cura Ancelle della Carità [Cremona, Italia]
6 NTNU [Ålesund]
7 HUPT - Hospital Universitari Parc Taulí [Sabadell, Spain]
8 CIBER de Epidemiología y Salud Pública (CIBERESP)
9 RCCS–Istituto di Ricerche Farmacologiche “Mario Negri [Bergamo, Italy]
10 Hunimed - Humanitas University [Milan]
11 Aarhus University Hospital
12 ASST Great Metropolitan Niguarda / ASST Grande Ospedale Metropolitano Niguarda [Milan, Italia]
13 The Mater Hospital - Mater Misericordiae University Hospital
14 NMS - NOVA Medical School - Faculdade de Ciências Médicas
15 Ghent University Hospital
16 Karolinska University Hospital [Stockholm]
17 Geneva University Hospitals and Geneva University
18 Utrecht University [Utrecht]
19 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
20 CSH - Cardinal Schwarzenberg Hospital [Pongau, Austria]
21 St George’s University Hospitals
22 Royal Devon and Exeter NHS Foundation Trust [UK]
23 Linköping university hospital
24 University of Bern
25 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
26 EWI - European Wellness International [Luhansk, Ukraine]
27 AH - Alkhums Hospital [Tripoli, Libya]
28 University Hospital of Larissa
29 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
30 UiB - University of Bergen
31 Haukeland University Hospital
Finn H Andersen
  • Function : Author
Maurizio Cecconi


Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of lifesustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered-together with illness severity and pre-existing functional capacity-to effectively guide triage decisions. Trial registration: NCT03134807 and NCT03370692.
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Dates and versions

inserm-03472839 , version 1 (09-12-2021)



Raphael Romano Bruno, Bernhard Wernly, Malte Kelm, Ariane Boumendil, Alessandro Morandi, et al.. Management and outcomes in critically ill nonagenarian versus octogenarian patients. BMC Geriatrics, 2021, 21 (1), pp.576. ⟨10.1186/s12877-021-02476-4⟩. ⟨inserm-03472839⟩
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