Critically ill elderly patients (≥ 90 years): Clinical characteristics, outcome and financial implications

BackgroundPatients aged over 90 are being admitted to intensive care units (ICUs) with increasing frequency. The appropriateness of such decisions still remains controversial due to questionable outcome, limited resources and costs. Our objective was to determine the clinical characteristics and outcome in elderly patients (≥ 90 years) admitted in a medical ICU, with an additional focus on medico-economic implications.MethodsWe reviewed the charts of all patients (≥ 90 years) admitted to our ICU. We compared them with all other ICU patients (ResultsIn the study group of 317 stays: median age was 92 years (IQR: 91–94 years); most patients were female (71.3%.). Acute respiratory failure (52.4%) was the main admission diagnosis; mean SAPS II was 55.6±21.3; half the stays (49.2%) required mechanical ventilation (duration: 7.2±8.8 days); withholding and withdrawing decisions were made for 33.4% of all stays. ICU and hospital mortality rates were 35.7% and 42.6% respectively. Mechanical ventilation (OR = 4.83, CI95%: 1.59–15.82) was an independent predictor of ICU mortality whereas age was not (OR = 0.88, CI95%: 0.72–1.08). Social security reimbursement was significantly lower in the study group compared with all other ICU stays, both per stay (13,160 vs 22,092 Euros, pConclusionAmong critically ill elderly patients (≥ 90 years), chronological age was not an independent factor of ICU mortality. ICU care-related costs in this population should not be considered as a limiting factor for ICU admission.

背景：90岁以上老年患者收治于重症监护病房（ICU）的频次逐年升高。由于此类患者的预后存疑、医疗资源有限且治疗成本高昂，此类收治决策的合理性仍存在广泛争议。本研究旨在明确收治于内科重症监护病房的≥90岁老年患者的临床特征与预后，并额外聚焦其医疗经济学层面的影响。
方法：我们回顾了本院ICU收治的所有≥90岁患者的病历，并将其与其余所有ICU收治患者进行对照。
结果：本研究共纳入317例次收治病例：患者中位年龄为92岁（四分位间距IQR：91~94岁）；其中多数为女性（71.3%）。急性呼吸衰竭（52.4%）为最主要的入院诊断；患者的简化急性生理学评分II（SAPS II）平均得分为55.6±21.3；49.2%的收治病例需接受机械通气（通气时长为7.2±8.8天）；33.4%的病例被实施了终止或撤除生命支持的医疗决策。ICU及住院病死率分别为35.7%与42.6%。机械通气（比值比Odds Ratio=4.83，95%置信区间95% CI：1.59~15.82）是ICU病死率的独立预测因素，而年龄并非独立预测因素（OR=0.88，95%CI：0.72~1.08）。本研究组的社保报销金额显著低于其余ICU收治病例，每例次报销金额分别为13160欧元与22092欧元，P值原文未完整呈现。
结论：在≥90岁的重症老年患者中，实际年龄并非ICU病死率的独立影响因素。此类人群的ICU治疗相关成本不应作为ICU收治的限制因素。