Management and outcomes in critically ill nonagenarian versus octogenarian patients
Authors: Bruno Raphael Romano , Wernly Bernhard , Kelm Malte , Boumendil Ariane , Morandi Alessandro , Andersen Finn H. , Artigas Antonio , Finazzi Stefano , Cecconi Maurizio , Christensen Steffen , Faraldi Loredana , Lichtenauer Michael , Muessig Johanna M. , Marsh Brian , Moreno Rui , Oeyen Sandra , Öhman Christina Agvald , Pinto Bernardo Bollen , Soliman Ivo W. , Szczeklik Wojciech , Valentin Andreas , Watson Ximena , Leaver Susannah , Boulanger Carole , Walther Sten , Schefold Joerg C. , Joannidis Michael , Nalapko Yuriy , Elhadi Muhammed , Fjølner Jesper , Zafeiridis Tilemachos , De Lange Dylan W. , Guidet Bertrand , Flaatten Hans , Jung Christian ,   on behalf of the VIP2 study group, Joannidis Michael , Eller Philipp , Helbok Raimund , Schmutz René , Nollet Joke , de Neve Nikolaas , Buysscher Pieter De , Oeyen Sandra , Swinnen Walter , Mikačić Marijana , Bastiansen Anders , Husted Andreas , Dahle Bård E. S. , Cramer Christine , Sølling Christoffer , Ørsnes Dorthe , 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 Mc Donald , 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 , Leaver Susannah , Mane Tarkeshwari , Lawton Tom , Ogbeide Vongayi , Khaliq Waqas , Baird Yolanda , Romen Antoine , Galbois Arnaud , Guidet Bertrand , Vinsonneau Christophe , Charron Cyril , Thevenin Didier , Guerot Emmanuel , Besch Guillaume , Savary Guillaume , Mentec Hervé , Chagnon Jean-Luc , Rigaud Jean-Philippe , Quenot Jean-Pierre , Castanera 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 , Tasioudis Polychronis , Zidianakis Vasiiios , Konstantinia Vryza , Aidoni Zoi , Marsh Brian , 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 W. , van Boven Eva , Haringman Jasper , Haas Lenneke , van den Berg Lettie , Hoiting Oscar , de 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 , Fernandes Pinto Alexandre , 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 , Walther Sten , Boroli Filippo , Schefold Joerg C. , Hergafi Leila , Eckert Philippe , Yıldız Ismail , Yovenko Ihor , Nalapko Yuriy , Pugh Richard 
Published: October 2021

Abstract
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.

Trial registration
NCT03134807 and NCT03370692.