Unplanned admission to the intensive care unit in the very elderly and risk of in-hospital mortality.
BACKGROUND
Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined.


OBJECTIVE
To estimate the risk of in-hospital mortality associated with unplanned admission to the ICU in patients aged 80 years and over.


METHODS
Retrospective review of an adult intensive care database. The setting was Liverpool Hospital, a large teaching hospital in Sydney, Australia, with a 28-bed ICU that has about 2000 admissions per year. We analysed data on very elderly patients (n = 1680), aged 80 years or more, admitted to the ICU between 1 January 1997 and 31 December 2007.


METHODS
Baseline risk factors for inhospital mortality.


RESULTS
Mortality among patients with unplanned ICU admissions was 47%, compared with 25% in patients with planned admissions (adjusted rate ratio [RR], 1.92 [95% CI, 1.59-2.32]). An estimated 50% of the overall risk of inhospital death among very elderly patients was attributable to a combination of unplanned admission to the ICU, the presence of at least one comorbid condition, acute renal failure and respiratory failure requiring intubation.


CONCLUSIONS
Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.
Department of Intensive Care, Liverpool Hospital, Sydney, NSW. s.frost@uws.edu.au.
Steven A
SA
Frost
Patricia M
PM
Davidson
Evan
E
Alexandrou
Leanne
L
Hunt
Yenna
Y
Salamonson
Victor
V
Tam
Michael Ja
MJ
Parr
Anders
A
Aneman
Ken M
KM
Hillman
D000368:Aged; D015897:Comorbidity; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D012189:Retrospective Studies