title: Predicting short-term and long-term mortality in elderly emergency patients admitted for intensive care.
abstract: OBJECTIVE
  The long-term outcomes of intensive care for the growing elderly cohort are not well defined. We explored the predictive factors for 12-month mortality in elderly patients who were admitted to an intensive care unit within 24 hours of emergency department (ED) presentation.
  
  
  METHODS
  A retrospective cohort study of 506 patients aged 80 years and over who were admitted to the Royal Melbourne Hospital ICU within 24 hours of presentation to the ED, between 1 January 2005 and 1 December 2010.
  
  
  RESULTS
  After multivariate regression analysis, independent risk factors for mortality 12 months after hospital discharge were the need for mechanical ventilation (odds ratio [OR], 5.16; 95% CI, 3.00-8.86), presence of acute renal failure (OR, 4.71; 95% CI, 2.04-10.84), age (OR, 1.07; 95% CI, 1.01-1.14), Glasgow coma score (GCS) (OR, 0.89; 95% CI, 0.84-0.93) and serum urea level (OR, 1.05; 95% CI, 1.02-1.07). Independent predictors for mortality in the ICU were the presence of acute renal failure (OR, 14.96; 95% CI, 6.50- 34.44), the need for mechanical ventilation (OR, 8.13; 95% CI, 2.77-23.89), and GCS (OR, 0.85; 95% CI, 0.79-0.90). Mortality in the ICU was 16.6%, and 12 months after hospital discharge was 46.3%.
  
  
  CONCLUSIONS
  Physiological parameters present on admission to the ICU including acute renal failure, the need for mechanical ventilation, a low GCS and high serum urea level, as well as age, have independent predictive value for 12-month mortality, but comorbidities were not predictive. This may help clinicians with decisions about who will benefit most from intensive care treatment.
authors: Royal Melbourne Hospital, Melbourne, VIC, Australia. daiv.lown@mh.org.au
authors: Daiv J
authors: DJ
authors: Lown
authors: Jonathon
authors: J
authors: Knott
authors: Thomas
authors: T
authors: Rechnitzer
authors: Chris
authors: C
authors: Maclsaac
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors