Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit.
BACKGROUND
The aim of this study was to evaluate factors influencing short- and long-term survival in medical patients aged 80 and over following admission to an intensive care unit.


METHODS
All patients aged 80 years or over and admitted between 2001 and 2006 were included in this study. Survival was evaluated between the time of admission and June 2009; factors associated with mortality were determined. Health-related quality of life was evaluated using Short Form (SF)-36 in long-term survivors.


RESULTS
For the 299 patients included (mean age, 84 ± 4 y), hospital mortality was 55%. Factors independently associated with hospital mortality were a higher SAPS II score at ICU admission; the existence of a fatal disease as reflected by the McCabe score and a cardiac diagnosis at admission. In the 133 hospital survivors, median survival time was 710 days (95% CI, 499-921). Two-year mortality rates were 79% of the initial cohort and 53% of hospital survivors. The standardized ratio of mortality at 2 years after hospital discharge was 2.56 (95% CI, 2.08-3.12) when compared with age- and gender-adjusted mortality of the general population. Factors independently associated with mortality at 2 years after hospital discharge were SAPS II score at ICU admission and the McCabe score. Conversely, functional status prior to admission as assessed by Knaus or Karnofsky scores was not associated with long-term mortality. In long-term survivors, SF-36 physical function scores were poor but scores for pain, emotional well-being and social function were not much affected.


CONCLUSIONS
The severity of acute disease at admission influences mortality at the hospital and following discharge in patients aged 80 or over. Although up to 50% of patients discharged from the hospital were still alive at 2 years, mortality was increased when compared with the general population. Physical function of long-term hospital survivors was greatly altered.
Medical Intensive Care Unit, Hôpital Nord, Chemin des Bourrely, Marseille 13015, France. antoine.roch@ap-hm.fr
Antoine
A
Roch
Sandrine
S
Wiramus
Vanessa
V
Pauly
Jean-Marie
JM
Forel
Christophe
C
Guervilly
Marc
M
Gainnier
Laurent
L
Papazian
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011446:Prospective Studies; D011788:Quality of Life; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors
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