Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study
Ibarz, Mercedes (Hospital Universitario Sagrat Cor)
Boumendil, Ariane (Hôpital Saint-Antoine)
Haas, Lenneke E. M. (Diakonessenhuis Utrecht)
Irazabal, Marian (Hospital Universitari General de Catalunya)
Flaatten, Hans (University of Bergenl Medicine)
De Lange, Dylan W.. (University of Utrecht)
Morandi, Alessandro (Geriatric Research Group)
Andersen, Finn H. (NTNU, Department of Circulation and Medical Imaging)
Bertolini, Guido (Instituto di Ricerche Farmacologiche "Mario Negri" Ranica)
Cecconi, Maurizio (Humanitas University)
Christensen, Steffen (Aarhus University Hospital (Aarhus, Dinamarca))
Faraldi, Loredana (ASST Grande Ospedale Metropolitano Niguarda)
Fjølner, Jesper (Aarhus University Hospital (Aarhus, Dinamarca))
Jung, Christian (University Hospital)
Marsh, Brian (Mater Misericordiae University Hospital(Dublín, Irlanda))
Moreno, Rui (Centro Hospitalar de Lisboa Central)
Oeyen, Sandra (Universitair Ziekenhuis Gent)
Öhman, Christina Agwald (Karolinska University Hospital and Karolinska Institutet (Suècia))
Bollen Pinto, Bernardo (Geneva University Hospitals (Suïssa))
Soliman, Ivo W. (University of Utrecht)
Szczeklik, Wojciech (Jagiellonian University Medical College)
Valentin, Andreas (Kardinal Schwarzenberg Hospital (Àustria))
Watson, Ximena (St George's University Hospital)
Zaferidis, Tilemachos (General University Hospital of Larissa (Grècia))
Guidet, Bertrand (Institute Pierre Louis d'Épidémiologie et de Santé Publique)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Universitat Autònoma de Barcelona

Data:	2020
Resum:	The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12. 7%) [53. 8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0. 0001), required more vasoactive drugs [82. 2% vs. 55. 1%, p < 0. 0001] and renal replacement therapies [17. 4% vs. 9. 9%; p < 0. 0001], and had more life-sustaining treatment limitations [37. 3% vs. 32. 1%; p = 0. 02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0. 99 (95% CI 0. 86-1. 15), p = 0. 917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1. 00 (95% CI 0. 87-1. 17), p = 0. 95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57. 2% (95% CI 52. 7-60. 7) vs. 57. 1% (95% CI 53. 7-60. 1), p = 0. 85]. After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Sepsis ; Very old ; Intensive care ; Severity of illness ; Outcome ; Survival ; Mortality
Publicat a:	Annals of Intensive Care, Vol. 10 (may 2020) , ISSN 2110-5820

DOI: 10.1186/s13613-020-00672-w
PMID: 32406016

12 p, 1.2 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
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