Sepsis at ICU admission does not decrease 30-day survival in very old patients
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10362/104137 |
Resumo: | Background: 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. Results: 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]. Conclusions: 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. |
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Sepsis at ICU admission does not decrease 30-day survival in very old patientsa post-hoc analysis of the VIP1 multinational cohort studyIntensive careMortalityOutcomeSepsisSeverity of illnessSurvivalVery oldCritical Care and Intensive Care MedicineBackground: 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. Results: 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]. Conclusions: 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.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNIbarz, MercedesBoumendil, ArianeHaas, Lenneke E.M.Irazabal, MarianFlaatten, Hansde Lange, Dylan W.Morandi, AlessandroAndersen, Finn H.Bertolini, GuidoCecconi, MaurizioChristensen, SteffenFaraldi, LoredanaFjølner, JesperJung, ChristianMarsh, BrianMoreno, RuiOeyen, SandraÖhman, Christina AgwaldBollen Pinto, BernardoSoliman, Ivo W.Szczeklik, WojciechValentin, AndreasWatson, XimenaZaferidis, TilemachosGuidet, BertrandArtigas, AntonioSchmutz, RenéWimmer, FranzEller, PhilippJoannidis, MichaelDe Buysscher, PieterDe Neve, NikolaasOeyen, SandraSwinnen, WalterBollen Pinto, BernardoAbraham, PaulHergafi, LeilaSchefold, Joerg C.Biskup, EwelinaPiza, PetrTaliadoros, IoannisFjølner, JesperDey, NilanjanSølling, ChristofferRasmussen, Bodil SteenChristensen, SteffenForceville, XavierBesch, GuillaumeMentec, HerveMichel, Philippe2020-09-15T22:46:23Z2020-12-012020-12-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/104137eng2110-5820PURE: 19845678https://doi.org/10.1186/s13613-020-00672-winfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-05-22T17:47:32Zoai:run.unl.pt:10362/104137Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-05-22T17:47:32Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Sepsis at ICU admission does not decrease 30-day survival in very old patients a post-hoc analysis of the VIP1 multinational cohort study |
title |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
spellingShingle |
Sepsis at ICU admission does not decrease 30-day survival in very old patients Ibarz, Mercedes Intensive care Mortality Outcome Sepsis Severity of illness Survival Very old Critical Care and Intensive Care Medicine |
title_short |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
title_full |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
title_fullStr |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
title_full_unstemmed |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
title_sort |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
author |
Ibarz, Mercedes |
author_facet |
Ibarz, Mercedes Boumendil, Ariane Haas, Lenneke E.M. Irazabal, Marian Flaatten, Hans de Lange, Dylan W. Morandi, Alessandro Andersen, Finn H. Bertolini, Guido Cecconi, Maurizio Christensen, Steffen Faraldi, Loredana Fjølner, Jesper Jung, Christian Marsh, Brian Moreno, Rui Oeyen, Sandra Öhman, Christina Agwald Bollen Pinto, Bernardo Soliman, Ivo W. Szczeklik, Wojciech Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand Artigas, Antonio Schmutz, René Wimmer, Franz Eller, Philipp Joannidis, Michael De Buysscher, Pieter De Neve, Nikolaas Swinnen, Walter Abraham, Paul Hergafi, Leila Schefold, Joerg C. Biskup, Ewelina Piza, Petr Taliadoros, Ioannis Dey, Nilanjan Sølling, Christoffer Rasmussen, Bodil Steen Forceville, Xavier Besch, Guillaume Mentec, Herve Michel, Philippe |
author_role |
author |
author2 |
Boumendil, Ariane Haas, Lenneke E.M. Irazabal, Marian Flaatten, Hans de Lange, Dylan W. Morandi, Alessandro Andersen, Finn H. Bertolini, Guido Cecconi, Maurizio Christensen, Steffen Faraldi, Loredana Fjølner, Jesper Jung, Christian Marsh, Brian Moreno, Rui Oeyen, Sandra Öhman, Christina Agwald Bollen Pinto, Bernardo Soliman, Ivo W. Szczeklik, Wojciech Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand Artigas, Antonio Schmutz, René Wimmer, Franz Eller, Philipp Joannidis, Michael De Buysscher, Pieter De Neve, Nikolaas Swinnen, Walter Abraham, Paul Hergafi, Leila Schefold, Joerg C. Biskup, Ewelina Piza, Petr Taliadoros, Ioannis Dey, Nilanjan Sølling, Christoffer Rasmussen, Bodil Steen Forceville, Xavier Besch, Guillaume Mentec, Herve Michel, Philippe |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
dc.contributor.author.fl_str_mv |
Ibarz, Mercedes Boumendil, Ariane Haas, Lenneke E.M. Irazabal, Marian Flaatten, Hans de Lange, Dylan W. Morandi, Alessandro Andersen, Finn H. Bertolini, Guido Cecconi, Maurizio Christensen, Steffen Faraldi, Loredana Fjølner, Jesper Jung, Christian Marsh, Brian Moreno, Rui Oeyen, Sandra Öhman, Christina Agwald Bollen Pinto, Bernardo Soliman, Ivo W. Szczeklik, Wojciech Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand Artigas, Antonio Schmutz, René Wimmer, Franz Eller, Philipp Joannidis, Michael De Buysscher, Pieter De Neve, Nikolaas Oeyen, Sandra Swinnen, Walter Bollen Pinto, Bernardo Abraham, Paul Hergafi, Leila Schefold, Joerg C. Biskup, Ewelina Piza, Petr Taliadoros, Ioannis Fjølner, Jesper Dey, Nilanjan Sølling, Christoffer Rasmussen, Bodil Steen Christensen, Steffen Forceville, Xavier Besch, Guillaume Mentec, Herve Michel, Philippe |
dc.subject.por.fl_str_mv |
Intensive care Mortality Outcome Sepsis Severity of illness Survival Very old Critical Care and Intensive Care Medicine |
topic |
Intensive care Mortality Outcome Sepsis Severity of illness Survival Very old Critical Care and Intensive Care Medicine |
description |
Background: 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. Results: 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]. Conclusions: 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. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-09-15T22:46:23Z 2020-12-01 2020-12-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/104137 |
url |
http://hdl.handle.net/10362/104137 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2110-5820 PURE: 19845678 https://doi.org/10.1186/s13613-020-00672-w |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
mluisa.alvim@gmail.com |
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1817545758115627008 |