Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Dylan W de Lange¹, Sylvia Brinkman², Hans Flaatten^{3

4}, Ariane Boumendil⁵, Alessandro Morandi^{6

7}, Finn H Andersen^{8

9}, Antonio Artigas¹⁰, Guido Bertolini¹¹, Maurizio Cecconi¹², Steffen Christensen¹³, Loredana Faraldi¹⁴, Jesper Fjølner¹³, Christian Jung¹⁵, Brian Marsh¹⁶, Rui Moreno¹⁷, Sandra Oeyen¹⁸, Christina Agvald Öhman¹⁹, Bernardo Bollen Pinto²⁰, Anne Marie G A de Smet²¹, Ivo W Soliman¹, Wojciech Szczeklik²², Andreas Valentin²³, Ximena Watson¹², Tilemachos Zafeiridis²⁴, Bertrand Guidet^{5

25

26}; VIP1 Study Group

Affiliations

¹ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
² Department of Medical Informatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
⁵ Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.
⁶ Department of Rehabilitation, Hospital Ancelle di Cremona, Cremona, Italy.
⁷ Geriatric Research Group, Brescia, Italy.
⁸ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
⁹ Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
¹⁰ Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
¹¹ Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Ranica (Bergamo), Italy.
¹² St George's University Hospital, London, United Kingdom.
¹³ Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Denmark.
¹⁴ ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁵ Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
¹⁶ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁷ Unidade de Cuidados Intensivos Neurocriticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central Nova Medical School, Lisbon, Portugal.
¹⁸ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁹ Karolinska University Hospital, Stockholm, Sweden.
²⁰ Geneva University Hospitals, Geneva, Switzerland.
²¹ Department of Critical Care, University Medical Center Groningen, University Groningen, Groningen, The Netherlands.
²² Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
²³ Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
²⁴ Intensive Care Unit, General Hospital of Larissa Tsakalof Larissa, Larissa, Greece.
²⁵ Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
²⁶ ICU, hospital Saint Antoine, APHP, Paris, France.

PMID: 30977911
PMCID: PMC6850576
DOI: 10.1111/jgs.15888

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Dylan W de Lange et al. J Am Geriatr Soc. 2019 Jun.

. 2019 Jun;67(6):1263-1267.

doi: 10.1111/jgs.15888. Epub 2019 Apr 12.

Authors

Affiliations

¹ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
² Department of Medical Informatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
⁵ Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.
⁶ Department of Rehabilitation, Hospital Ancelle di Cremona, Cremona, Italy.
⁷ Geriatric Research Group, Brescia, Italy.
⁸ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
⁹ Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
¹⁰ Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
¹¹ Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Ranica (Bergamo), Italy.
¹² St George's University Hospital, London, United Kingdom.
¹³ Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Denmark.
¹⁴ ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁵ Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
¹⁶ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁷ Unidade de Cuidados Intensivos Neurocriticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central Nova Medical School, Lisbon, Portugal.
¹⁸ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁹ Karolinska University Hospital, Stockholm, Sweden.
²⁰ Geneva University Hospitals, Geneva, Switzerland.
²¹ Department of Critical Care, University Medical Center Groningen, University Groningen, Groningen, The Netherlands.
²² Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
²³ Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
²⁴ Intensive Care Unit, General Hospital of Larissa Tsakalof Larissa, Larissa, Greece.
²⁵ Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
²⁶ ICU, hospital Saint Antoine, APHP, Paris, France.

PMID: 30977911
PMCID: PMC6850576
DOI: 10.1111/jgs.15888

Abstract

Objectives: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs).

Design: Prospective cohort study.

Setting: A total of 306 ICUs from 24 European countries.

Participants: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male).

Measurements: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves.

Results: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die.

Conclusion: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity.

Keywords: critical care; model; older adults; predict; prognosis.

PubMed Disclaimer

Figures

**Figure 1**
Sensitivity and specificity of the simple bedside model for 30‐day mortality. When a patient has >10 points on the Cumulative Prognostic Score (CPS), that patient has a 50.6% positive predictive value (PPV) on 30‐day mortality and a negative predictive value (NPV) of 85.8%. The other values are as follows: at >12 points, a PPV of 55.9% and an NPV of 81.1%; at >16 points, a PPV of 67.6% and an NPV of 69.2%; and at >20 points, a PPV of 77.0% and an NPV of 60.5%.

See this image and copyright information in PMC

References

1. Flaatten H, Artigas A, de Lange DW, et al. The status of ICM research and a future agenda for very elderly patients in the ICU. Intensive Care Med. 2017;43:1319‐1328. - PubMed
1. Laake JH, Dybwik K, Flaatten HK, Fonneland IL, Kvåle R, Strand K. Impact of the post–World War II generation on intensive care needs in Norway. Acta Anaesthesiol Scand. 2010;54(4):479‐484. - PubMed
1. Angus D. Admitting elderly patients to the intensive care unit—is it the right decision? JAMA. 2017;318:1443‐1444. - PubMed
1. Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30‐day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017;43:4940‐4948. - PubMed
1. Boumendil A, Angus DC, Guitonneau AL, et al. Variability of intensive care admission decisions for the very elderly. PLoS One. 2012;7:e34387. - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Affiliations

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Authors

Affiliations

Abstract

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources