title: Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group.
abstract: BACKGROUND
  Outcome of very elderly patients admitted in intensive care unit (ICU) was most often reported for octogenarians. ICU admission demands for nonagenarians are increasing. The primary objective was to compare outcome and intensity of treatment of octogenarians and nonagenarians.
  
  
  METHODS
  We performed an observational study in 12 ICUs of the Outcomerea™ network which prospectively upload data into the Outcomerea™ database. Patients >90 years old (case patients) were matched with patients 80-90 years old (control patients). Matching criteria were severity of illness at admission, center, and year of admission.
  
  
  RESULTS
  A total of 2419 patients aged 80 or older and admitted from September 1997 to September 2013 were included. Among them, 179 (7.9 %) were >90 years old. Matching was performed for 176 nonagenarian patients. Compared with control patients, case patients were more often hospitalized for unscheduled surgery [54 (30.7 %) vs. 42 (23.9 %), p < 0.01] and had less often arterial monitoring for blood pressure [37 (21 %) vs. 53 (30.1 %), p = 0.04] and renal replacement therapy [5 (2.8 %) vs. 14 (8 %), p = 0.05] than control patients. ICU [44 (25 %) vs. 36 (20.5 %), p = 0.28] or hospital mortality [70 (39.8 %) vs. 64 (36.4 %), p = 0.46] and limitation of life-sustaining therapies were not significantly different in case versus control patients, respectively. Only 16/176 (14 %) of case patients were transferred to a geriatric unit.
  
  
  CONCLUSIONS
  This multicenter study reported that nonagenarians represented a small fraction of ICU patients. When admitted, these highly selected patients received similar life-sustaining treatments, except RRT, than octogenarians. ICU and hospital mortality were similar between the two groups.
authors.affiliation: Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France. mgarrouste@hpsj.fr.|Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France. mgarrouste@hpsj.fr.
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.affiliation: Department of Biostatistics, Outcomerea, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Grégoire
authors.affiliation: Medical-Surgical ICU, AP-HP, Antoine Béclère University Hospital, Clamart, France.
authors.forename: Anne-Sylvie
authors.initials: AS
authors.lastname: Dumesnil
authors.affiliation: Department of Biostatistics, Outcomerea, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Pommier
authors.affiliation: Medical-Surgical, General Hospital, Dourdan, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jamali
authors.affiliation: Medical-Surgical ICU, General Hospital, Montfermeil, France.
authors.forename: Dany
authors.initials: D
authors.lastname: Golgran-Toledano
authors.affiliation: Medical ICU, Albert Michallon University Hospital, Grenoble, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Medical-Surgical ICU, AP-HP, Avicennes University Hospital, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Clec'h
authors.affiliation: Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France.
authors.forename: Lilia
authors.initials: L
authors.lastname: Soufir
authors.affiliation: Medical ICU, AP-HP, Tenon University Hospital, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: Medical-Surgical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Marcotte
authors.affiliation: Medical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.affiliation: Medical-Surgical ICU, Delafontaine University Hospital, Saint Denis, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Verdière
authors.affiliation: Medical-Surgical ICU, Saint Etienne University Hospital, Saint Priest en Jarez, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Medical ICU, AP-HP, Saint Louis University Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France.|Department of Biostatistics, Outcomerea, Paris, France.|Medical ICU, AP-HP, Bichat University Hospital, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
keywords: 80 and over; Elderly; End of life; Intensive care unit; Triage