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Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit

고윤석|임채만|홍상범|허진원|이송이
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2022.08|Acute and Critical Care|제37권 제3호|pp. 372-381|DOI 10.4266/acc.2022.00066

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키워드

mortalityaging societycritical carevery elderly

초록

Background: Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.Methods: We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.Results: Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.Conclusions: The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

Abstract

Background: Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.Methods: We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.Results: Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.Conclusions: The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

참고문헌 (30)

  1. "100 Indicators of KOSIS" (2021)[URL]
  2. Kim KW, "Super aging in South Korea unstoppable but mitigatable : a sub-national scale population projection for best policy planning", Spat Demogr, 8, pp.155~173 (2020)
  3. Al-Dorzi HM, "Characteristics, management and outcomes of critically ill patients who are 80 years and older : a retrospective comparative cohort study", BMC Anesthesiol, 14, pp.126~ (2014)
  4. Knaus WA, "The APACHE III prognostic system : risk prediction of hospital mortality for critically ill hospitalized adults", Chest, 100, pp.1619~1636 (1991)
  5. 임정욱, "Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A Single-Center Retrospective Study", Acute and Critical Care, 32(2), pp.164~173 (2017), 대한중환자의학회
  6. Williams TA, "Long-term survival from intensive care : a review", Intensive Care Med, 31, pp.1306~1315 (2005)
  7. Le Gall JR, "A new Simplified Acute Physiology Score(SAPS II)based on a European", North American multicenter study, 1993, pp.270, 2957~2963
  8. 이승훈, "Outcomes of very elderly (≥ 80 years) critical-ill patients in a medical intensive care unit of a tertiary hospital in Korea", The Korean Journal of Internal Medicine, 32(4), pp.675~681 (2017), 대한내과학회[DOI]
  9. Giannasi SE, "Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort", Med Intensiva(Engl Ed), 42, pp.482~489 (2018)
  10. Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
  11. Nguyen YL, "The challenge of admitting the very elderly to intensive care", Ann Intensive Care, 1, pp.29~ (2011)
  12. Garland A, "Epidemiology of critically ill patients in intensive care units : a population-based observational study", Crit Care, 17, pp.R212~ (2013)
  13. Moran JL, "Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database", Crit Care Med, 36, pp.46~61 (2008)
  14. Sim YS, "Mortality and outcomes in very elderly patients 90 years of age or older admitted to the ICU", Respir Care, 60, pp.347~355 (2015)
  15. 곽상현, "Current Status of Intensive Care Units Registered as Critical Care Subspecialty Training Hospitals in Korea", Journal of Korean Medical Science, 29(3), pp.431~437 (2014), 대한의학회
  16. 김정현, "Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea", Acute and Critical Care, 31(1), pp.25~33 (2016), 대한중환자의학회
  17. Kim DY, "Survival rates following medical intensive care unit admission from 2003 to 2013: an observational study based on a representative population-based sample cohort of Korean patients", Medicine (Baltimore), 98, pp.e17090~ (2013)
  18. 이수환, "Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015", Yonsei Medical Journal, 62(1), pp.50~58 (2021), 연세대학교의과대학[DOI]
  19. Kim S, "The association between nurse staffing level and length of stay in general ward and intensive care unit in Korea", Appl Nurs Res, 63, pp.151558~ (2022)
  20. 오탁규, "Trends in Mortality, Treatment, and Costs of Management of Acute Respiratory Distress Syndrome in South Korea: Analysis of Data between 2010 and 2019", Yonsei Medical Journal, 63(5), pp.452~460 (2022), 연세대학교의과대학[DOI]
  21. Kaukonen KM, "Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012", JAMA, 311, pp.1308~1316 (2014)
  22. Roch A, "Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit", Crit Care, 15, pp.R36~ (2011)
  23. Vincent JL, "Use of the SOFA score to assess the incidence of organ dysfunction", failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine, 1998, pp.26, 1793~1800
  24. Salluh JI, "ICU severity of illness scores : APACHE, SAPS and MPM", Curr Opin Crit Care, 20, pp.557~565 (2014)
  25. Htwe TH, "Infection in the elderly", Infect Dis Clin North Am, 21, pp.711~743 (2007)
  26. Martin-Loeches I, "Risk factors for mortality in elderly and very elderly critically ill patients with sepsis : a prospective, observational, multicenter cohort study", Ann Intensive Care, 9, pp.26~ (2019)
  27. Mukhopadhyay A, "Risk factors for hospital and long-term mortality of critically ill elderly patients admitted to an intensive care unit", Biomed Res Int, 2014, pp.960575~ (2014)
  28. Atramont A, "Association of age with short-term and long-term mortality among patients discharged from intensive care units in France", JAMA Netw Open, 2, pp.e193215~ (2019)
  29. Vallet H, "Mortality of older patients admitted to an ICU : a systematic review", Crit Care Med, 49, pp.324~334 (2021)
  30. de Rooij SE, "Factors that predict outcome of intensive care treatment in very elderly patients : a review", Crit Care, 9, pp.R307~R314 (2005)

관련 논문AI추천

Outcomes of very elderly (≥ 80 years) critical-ill patients in a medical intensive care unit of a tertiary hospital in Korea김호철, 유정완, 이승준, 이승훈, 이종덕, 이태원, 정이영, 조유지, 주선미대한내과학회 · The Korean Journal of Internal Medicine2017 · 제32권 제4호Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea김영환, 김정현, 박영식, 유철규, 이상민, 이정규, 이진우, 이창훈, 임재준, 최선미, 한성구대한중환자의학회 · Acute and Critical Care2016 · 제31권 제1호Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A Single-Center Retrospective Study강현희, 문화식, 이상학, 이종민, 임정욱, 하직환대한중환자의학회 · Acute and Critical Care2017 · 제32권 제2호요양병원 전원 노인 환자의 종합병원 중환자실 재원기간 영향요인신동수, 이수정, 정이슬한국보건정보통계학회 · 보건정보통계학회지2020 · 제45권 제4호Changes in the Characteristics and Long-term Mortality Rates of Intensive Care Unit Patients from 2003 to 2010: A Nationwide Population-Based Cohort Study Performed in the Republic of Korea권재우, 김영주, 김우진, 문기원, 이승준, 이승환, 한선숙, 홍윤기, Jae Hoon Jeong, Jeongwon Heo대한중환자의학회 · Acute and Critical Care2018 · 제33권 제3호Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015김영삼, 박은철, 이선민, 이수환, 한창훈, 홍정화연세대학교의과대학 · Yonsei Medical Journal2021 · 제62권 제1호

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