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Wyświetlanie 1-10 z 11
Tytuł:
Cumulative prognostic score oredicting mortality in patients older than 80 years admitted to the ICU
Autorzy:
Valentin, Andreas
Guidet, Bertrand
Morandi, Alessandro
Jung, Christian
Zafeiridis, Tilemachos
Brinkman, Sylvia
Christensen, Steffen
de Smet, Anne Marie G.A.
Szczeklik, Wojciech
Bollen Pinto, Bernadro
Watson, Ximena
Moreno, Rui
Faraldi, Loredana
Oeyen, Sandra
Artigas, Antonio
Soliman, Ivo W.
Marsh, Brian
Cecconi, Maurizio
Flaatten, Hans
De Lange, Dylan W.
Bertolini, Guido
Boumendil, Ariane
Fjolner, Jesper
Andersen, Finn H.
Öhman, Christina Agvald
Opis:
OBJECTIVES To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN Prospective cohort study. SETTING A total of 306 ICUs from 24 European countries. PARTICIPANTS Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81‐87 y]; 51.8% male). MEASUREMENTS Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30‐day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS The 30‐day‐mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30‐day mortality in 91.1% of all patients who die. CONCLUSION A predictive model of cumulative events predicts 30‐day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision‐making capacity.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Relationship between the Clinical Frailty Scale and short-term mortality in patients > or = 80 years old acutely admitted to the ICU : a prospective cohort study
Autorzy:
Watson, Ximena
De Lange, Dylan W.
Valentin, Andreas
Moreno, Rui
Flaatten, Hans
Agvald-Ohman, Christina
Guidet, Bertrand
Polok, Kamil
Górka, Jacek
Artigas, Antonio
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Zafeiridis, Tilemachos
Fjolner, Jesper
Cecconi, Maurizio
Joannidis, Michael
Pinto, Bernardo Bollen
Walther, Sten
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Christensen, Steffen
Beil, Michael
Sviri, Sigal
van Heerden, Peter Vernon
Jung, Christian
Morandi, Alessandro
Rhodes, Andrew
Fronczek, Jakub
Opis:
Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Result: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion: Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Management and outcomes in critically ill nonagenarian versus octogenarian patients
Autorzy:
Watson, Ximena
De Lange, Dylan W.
Wernly, Bernhard
Valentin, Andreas
Faraldi, Loredana
Lichtenauer, Michael
Finazzi, Stefano
Moreno, Rui
Flaatten, Hans
Guidet, Bertrand
Ohman, Christina Agvald
Bruno, Raphael Romano
Artigas, Antonio
Szczeklik, Wojciech
Andersen, Finn H.
Leaver, Susannah
Zafeiridis, Tilemachos
Fjolner, Jesper
Cecconi, Maurizio
Joannidis, Michael
Pinto, Bernardo Bollen
Walther, Sten
Marsh, Brian
Oeyen, Sandra
Schefold, Joerg C.
Christensen, Steffen
Boulanger, Carole
Muessig, Johanna M.
Kelm, Malte
Soliman, Ivo W.
Jung, Christian
Boumendil, Ariane
Morandi, Alessandro
Elhadi, Muhammed
Nalapko, Yuriy
Opis:
Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Wyświetlanie 1-10 z 11

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