Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status.
OBJECTIVE
To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge.


METHODS
Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU.


METHODS
The ICU of a university hospital.


METHODS
One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours.


METHODS
A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU.


RESULTS
Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status.


CONCLUSIONS
Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.
Dardaine
V
V
Hôpital de l'Ermitage and Réanimation Médicale Polyvalente, Hôpital Bretonneau, CHU de Tours, Tours, France.
Dequin
P F
PF
Ripault
H
H
Constans
T
T
Giniès
G
G
D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D016638:Critical Illness / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008019:Life Style; D008297:Male; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000523:psychology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome