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Management and outcomes in critically ill nonagenarian versus octogenarian patients

Raphael Romano Bruno 1 Bernhard Wernly 2, 3 Malte Kelm 1 Ariane Boumendil 4 Alessandro Morandi 5 Finn H Andersen 6 Antonio Artigas 7, 8 Stefano Finazzi 9 Maurizio Cecconi 10 Steffen Christensen 11 Loredana Faraldi 12 Michael Lichtenauer 2 Johanna M Muessig 1 Brian Marsh 13 Rui Moreno 14 Sandra Oeyen 15 Christina Agvald Öhman 16 Bernardo Bollen Pinto 17 Ivo W Soliman 18 Wojciech Szczeklik 19 Andreas Valentin 20 Ximena Watson 21 Susannah Leaver 21 Carole Boulanger 22 Sten Walther 23 Joerg C Schefold 24 Michael Joannidis 25 Yuriy Nalapko 26 Muhammed Elhadi 27 Jesper Fjølner 11 Tilemachos Zafeiridis 28 Dylan W de Lange 18 Bertrand Guidet 4, 29 Hans Flaatten 30, 31 Christian Jung 1 
Abstract : 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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Submitted on : Thursday, December 9, 2021 - 3:29:23 PM
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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, BioMed Central, 2021, 21 (1), pp.576. ⟨10.1186/s12877-021-02476-4⟩. ⟨inserm-03472839⟩

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