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. 2021 Oct 19;21(1):576.
doi: 10.1186/s12877-021-02476-4.

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Raphael Romano Bruno #  1 , Bernhard Wernly #  2   3 , Malte Kelm  1   4 , Ariane Boumendil  5 , Alessandro Morandi  6   7 , Finn H Andersen  8   9 , Antonio Artigas  10 , Stefano Finazzi  11 , Maurizio Cecconi  12 , Steffen Christensen  13 , Loredana Faraldi  14 , Michael Lichtenauer  15 , Johanna M Muessig  1 , Brian Marsh  16 , Rui Moreno  17 , Sandra Oeyen  18 , Christina Agvald Öhman  19 , Bernardo Bollen Pinto  20 , Ivo W Soliman  21 , Wojciech Szczeklik  22 , Andreas Valentin  23 , Ximena Watson  24 , Susannah Leaver  25 , Carole Boulanger  26 , Sten Walther  27 , Joerg C Schefold  28 , Michael Joannidis  29 , Yuriy Nalapko  30 , Muhammed Elhadi  31 , Jesper Fjølner  32 , Tilemachos Zafeiridis  33 , Dylan W De Lange  21 , Bertrand Guidet  5   34   35 , Hans Flaatten  36   37 , Christian Jung  38 ; VIP2 study group
Collaborators, Affiliations

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Raphael Romano Bruno et al. BMC Geriatr. .

Abstract

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients.

Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians.

Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)).

Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.

Trial registration: NCT03134807 and NCT03370692 .

Keywords: Frailty; Intensive care medicine; Nonagenarians; Octogenarians; Outcome.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of 30-day and ICU-mortality. A: ICU-mortality [%], B: 30-day-mortality [%]. * = p < 0.05
See this image and copyright information in PMC

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