Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients
Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung, Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung
Abstract
Background: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation.
Methods: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis.
Results: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001).
Conclusions: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).
Keywords: ICU; critically ill; elderly subjects; mechanical ventilation; risk scores; risk stratification.
Conflict of interest statement
The authors have disclosed no conflicts of interest.
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Source: PubMed