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Critical Care |

The Association of Older Age and Development of ARDS in Critically Ill Patients FREE TO VIEW

Daniel Reynolds, MD; Rahul Kashyap, MBBS; Ognjen Gajic, MD
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Mayo Clinic, Rochester, MN


Chest. 2015;148(4_MeetingAbstracts):184A. doi:10.1378/chest.2229085
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Abstract

SESSION TITLE: ARDS Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The prevalence of most risk factors for Acute Respiratory Distress Syndrome (ARDS) is higher in the elderly. However the role of age per se as a modifying factor for ARDS development remains under studied. We sought to study the association between older age and development of ARDS in hospitalized patients at risk of this complication.

METHODS: This is a secondary analysis of a previously reported multicenter observational cohort of hospitalized patients at risk of ARDS admitted to 22 hospitals over a 6-month period (LIPS 1 cohort). The development of ARDS was compared between elderly patients (Age ≥70 and ≥80) and younger patients. A multivariate logistic regression model was used, to adjust for severity of illness and risk of ARDS (Lung Injury Prediction Score -LIPS).

RESULTS: The final cohort consisted of 5,584 patients, of which 56.5% were male, with a median (IQR) age of 57 (43-70) years. ARDS was diagnosed in 229 (4.1%) patients. Risk of ARDS was similar in patients less than 70 years old (median LIPS 2.5 (1.5-4, n=4211), >70 years old (median LIPS 3(2-4.5), n=1373) and >80 years old (median LIPS 3 (2-4.5), n=694). The rate of ARDS development was 4.4% in those <70 years old, 4% in those >70 years old and 2.2% in those >80 years old, p=0.02. Compared to younger patients the adjusted odds ratio (OR) for ARDS development was 0.45 (95% Confidence Interval 0.31-0.63); in patients ≥70 years old and 0.32 (95% CI 0.18-0.54); in patients ≥80 years old.

CONCLUSIONS: In a secondary analysis of a prospective cohort of patients at risk for ARDS, after adjusting for severity of illness and ARDS risk factors, older age was associated with decreased incidence of ARDS.

CLINICAL IMPLICATIONS: Several possibilities could explain the lower rates of ARDS in the elderly, such as relative immunosuppression, chest wall stiffness with decreased risk of volutrauma, and the lower likelihood of aggressive medical interventions.

DISCLOSURE: The following authors have nothing to disclose: Daniel Reynolds, Rahul Kashyap, Ognjen Gajic

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