The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years
Authors: de Lange Dylan W. , Soliman Ivo W. , Leaver Susannah , Boumendil Ariane , Haas Lenneke E. M. , Watson Ximena , Boulanger Carol , Szczeklik Wojciech , Artigas Antonio , Morandi Alessandro , Andersen Finn , Jung Christian , Moreno Rui , Walther Sten , Oeyen Sandra , Schefold Joerg C. , Cecconi Maurizio , Marsh Brian , Joannidis Michael , Nalapko Yuriy , Elhadi Muhammed , Fjølner Jesper , Guidet Bertrand , Flaatten Hans ,   the VIP2 study group, Eller Philipp , Helbok Raimund , Schmutz René , Nollet Joke , de Neve Nikolaas , De Buysscher Pieter , Swinnen Walter , Mikačić Marijana , Bastiansen Anders , Husted Andreas , Dahle Bård E S , Cramer Christine , Sølling Christoffer , Christensen Dorthe Ørsnes , Thomsen Jakob Edelberg , Pedersen Jonas Juul , Enevoldsen Mathilde Hummelmose , Elkmann Thomas , Kubisz-Pudelko Agnieszka , Pope Alan , Collins Amy , Raj Ashok S , Boulanger Carole , Frey Christian , Hart Ciaran , Bolger Clare , Spray Dominic , Randell Georgina , Filipe Helder , Welters Ingeborg D , Grecu Irina , Evans Jane , Cupitt Jason , Lord Jenny , Henning Jeremy , Jones Joanne , Ball Jonathan , North Julie , Salaunkey Kiran , De Gordoa Laura Ortiz-Ruiz , Bell Louise , Balasubramaniam Madhu , Vizcaychipi Marcela , Faulkner Maria , Mupudzi McDonald , Lea-Hagerty Megan , Reay Michael , Spivey Michael , Love Nicholas , Spittle Nick , Spittle Nick , White Nigel , Williams Patricia , Morgan Patrick , Wakefield Phillipa , Savine Rachel , Jacob Reni , Innes Richard , Kapoor Ritoo , Humphreys Sally , Rose Steve , Dowling Susan , Mane Tarkeshwari , Lawton Tom , Ogbeide Vongayi , Khaliq Waqas , Baird Yolanda , Romen Antoine , Galbois Arnaud , Vinsonneau Christophe , Charron Cyril , Thevenin Didier , Guerot Emmanuel , Besch Guillaume , Savary Guillaume , Mentec Hervé , Chagnon Jean-Luc , Rigaud Jean-Philippe , Quenot Jean-Pierre , Castaneray Jeremy , Rosman Jérémy , Maizel Julien , Tiercelet Kelly , Vettoretti Lucie , Hovaere Maud Mousset , Messika Messika , Djibré Michel , Rolin Nathalie , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Rabe Christian , Barth Eberhard , Ebelt Henning , Fuest Kristina , Franz Marcus , Horacek Michael , Schuster Michael , Meybohm Patrick , Bruno Raphael Romano , Allgäuer Sebastian , Dubler Simon , Schaller Stefan J , Schering Stefan , Steiner Stephan , Dieck Thorben , Rahmel Tim , Graf Tobias , Koutsikou Anastasia , Vakalos Aristeidis , Raitsiou Bogdan , Flioni Elli Niki , Neou Evangelia , Tsimpoukas Fotios , Papathanakos Georgios , Marinakis Giorgos , Koutsodimitropoulos Ioannis , Aikaterini Kounougeri , Rovina Nikoletta , Kourelea Stylliani , Polychronis Tasioudis , Zidianakis Vasiiios , Konstantinia Vryza , Aidoni Zoi , Motherway Catherine , Read Chris , Martin-Loeches Ignacio , Cracchiolo Andrea Neville , Morigi Aristide , Calamai Italo , Brusa Stefania , Elhadi Ahmed , Tarek Ahmed , Khaled Ala , Ahmed Hazem , Belkhair Wesal Ali , Cornet Alexander D , Gommers Diederik , de Lange Dylan , van Boven Eva , Haringman Jasper , Haas Lenneke , van den Berg Lettie , Hoiting Oscar , Jager Peter , Gerritsen Rik T , Dormans Tom , Dieperink Willem , Breidablik Alena , Breidablik Alena , Slapgard Anita , Rime Anne-Karin , Jannestad Bente , Sjøbøe Britt , Rice Eva , Andersen Finn H , Strietzel Hans Frank , Jensen Jan Peter , Langørgen Jørund , Tøien Kirsti , Strand Kristian , Hahn Michael , Klepstad Pål , Biernacka Aleksandra , Kluzik Anna , Kudlinski Bartosz , Maciejewski Dariusz , Studzińska Dorota , Hymczak Hubert , Stefaniak Jan , Solek-Pastuszka Joanna , Zorska Joanna , Cwyl Katarzyna , Krzych Lukasz J , Zukowski Maciej , Lipińska-Gediga Małgorzata , Pietruszko Marek , Piechota Mariusz , Serwa Marta , Czuczwar Miroslaw , Ziętkiewicz Mirosław , Kozera Natalia , Nasiłowski Paweł , Sendur Paweł , Zatorski Paweł , Galkin Piotr , Gawda Ryszard , Kościuczuk Urszula , Cyrankiewicz Waldemar , Gola Wojciech , Pinto Alexandre Fernandes , Fernandes Ana Margarida , Santos Ana Rita , Sousa Cristina , Barros Inês , Ferreira Isabel Amorim , Blanco Jacobo Bacariza , Carvalho João Teles , Maia Jose , Candeias Nuno , Catorze Nuno , Belskiy Vladislav , Lores Africa , Mira Angela Prado , Cilloniz Catia , Perez-Torres David , Maseda Emilio , Rodriguez Enver , Prol-Silva Estefania , Eixarch Gaspar , Gomà Gemma , Aguilar Gerardo , Velasco Gonzalo Navarro , Jaimes Marián Irazábal , Villamayor Mercedes Ibarz , Fernández Noemí Llamas , Cubero Patricia Jimeno , López-Cuenca Sonia , Tomasa Teresa , Sjöqvist Anders , Brorsson Camilla , Schiöler Fredrik , Westberg Henrik , Nauska Jessica , Sivik Joakim , Berkius Johan , Thiringer Karin Kleiven , De Geer Lina , Boroli Filippo , Schefold Joerg C , Hergafi Leila , Eckert Philippe , Yıldız Ismail , Yovenko Ihor , Pugh Richard 
Published: March 2024

Background

Premorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival.

Methods

Prospective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS).

Results

Overall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3–6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81–86) than patients dying within the first 6 months (median age 84, IQR 82–87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5–6 versus 6 points, IQR 3–6, p < 0.01).

Conclusions

We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making.

ClinicalTrials.gov: NCT03370692.