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TREATMENT INTENSITY AND FACTORS PREDICTING SHORT- AND LONG-TERM OUTCOMES IN ELDERLY PATIENTS ADMITTED TO INTENSIVE CARE UNITS FREE TO VIEW

Alfredo J. Astua, MD*; Faiz Ahmed, MD; Jagdeep Singh, MD; Ravi Nallamothu, MD; Wen Dombrowsky, MD; Humaira Mahbub, MD; Janet Shapiro, MD; Edward Eden, MD; Peter Homel, PhD; Hassan Khouli, MD
Author and Funding Information

St Luke's Roosevelt Hospital Center, New York, NY


Chest


Chest. 2009;136(4_MeetingAbstracts):29S. doi:10.1378/chest.136.4_MeetingAbstracts.29S-g
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Abstract

PURPOSE:  To determine short and long term mortality predictors in ICU elderly patients and assess six-month health related quality of life (HRQOL) after ICU care.

METHODS:  Patients ≥ 65 y/o admitted for > 24h to MICU, SICU, CCU at two hospitals prospectively enrolled. Data collection: demographics, ICU diagnosis, Glasgow coma score (GCS) on ICU admission, comorbidities, ICU interventions, and disposition. Validated HRQOL survey administered to patients or care takers at ICU admission and 6-month after hospital discharge. We enrolled 484 patients who met study inclusion criteria.

RESULTS:  367 patients (76%) alive at hospital discharge and 318 (66%) alive at 6-months. Age (odds ratio: OR 1.05 per year), GCS (OR: 088), mechanical ventilation (OR: 2.27), days with mental distress prior to ICU admission (OR; 1.01 per day), gastrointestinal and acute renal failure ICU admission diagnoses (OR: 3.06 and 8.20 respectively) were predictors of increased hospital mortality. Age (OR: 1.04 per year), GCS (OR: 0.92), disposition to nursing home (OR: 0.40), number of ICU interventions (OR: 1.42), admission to MICU (OR: 1.88) were predictors of death at 6-months. Baseline and follow up HRQOL were similar. However, HRQOL analysis based on interaction of age and time with 77.7 y/o used as cutoff, 6-month HRQOL significantly worsened compared to baseline in the “older” elderly ICU patients (>77.7 y/o) in all HRQOL categories: days physically unwell, days mentally unwell, days with health problems, general health, unhealthy days in past 30 days, percentage of days with mental distress.

CONCLUSION:  Large number of ICU elderly patients die within 6-month of hospital discharge. Six-month mortality is higher in older patients with higher GCS, and discharged to NH. Six-month HRQOL is significantly worse compared to baseline HRQOL in the “older” elderly ICU patients.

CLINICAL IMPLICATIONS:  As increasing number of elderly patients ≥ 65 are admitted to ICUs in the USA, the focus may be shifted to long term prognosis and quality of life outcome predictors. Our study sheds light on this important area.

DISCLOSURE:  Alfredo Astua, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

10:30 AM - 12:00 PM


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