Sepsis at ICU admission does not decrease 30-day survival in very old patients

Detalhes bibliográficos
Autor(a) principal: Ibarz, Mercedes
Data de Publicação: 2020
Outros Autores: 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
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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spelling 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
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author
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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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