Predictive Factors for Death and Long-Term Outcomes in Elderly Critically Ill Patients Following Tracheotomy: A Prospective Analysis
Authors: zhao jingjing , zhan yuan , Chen Ting , Ling Gaoqiang , Fang Xiang , Yao Li 
Published: November 2024

Abstract

Objective To explore the factors influencing death in elderly critically ill patients within 3 months and 6 months after tracheotomy and to discuss the long-term quality of life of patients and the burden on caregivers by disease type.
Methods This prospective study included the general information of elderly tracheostomy patients who were successfully weaned after tracheotomy and discharged from the intensive care unit of Hefei Hospital Affiliated with Anhui Medical University between December 2018 and December 2022. Clinical data, laboratory data, and family status data (number of children, number of medical treatments and consultations) were used to analyze the risk factors for 3-month and 6-month mortality using single-factor analysis and multifactor logistic regression, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each risk factor for patient death. The study subjects were divided into three groups according to disease type: 45 patients in the cerebrovascular disease group (Group A), 77 patients in the heart failure+severe pneumoniagroup (Group B), and 38 patients in the postoperative complications group (Group C). Kaplan-Meier survival curves and log-rank tests were used to analyze the differences in survival rates among the three groups, and the Personal Activities of Daily Living (PADL) scale, SF-12 scale and Zarit Burden Interview (ZBI) were used to analyze and compare patients' quality of life.
Results One hundred sixty elderly critically ill patients were included. During the 3-month follow-up period, 22 patients died. Univariate analysis revealed that patients who died had better APACHE II scores (16.50±4.21 vs. 14.22±5.01, P<0.05) and PSI scores than did those who survived. The differences in the indicators were statistically significant. Multivariate logistic regression analysis revealed that the PSI score (OR=1.022, 95% CI: 1.008~1.036, P<0.01), total dose of vasoactive drugs (OR=1.004, 95% CI: 1.001~1.007, P<0.05) and number of medical consultations (OR=0.623, 95% CI: 0.418~0.929, P<0.05) were independent risk factors for death within 3 months after tracheotomy in elderly patients. ROC curve analysis revealed that the areas under the curve (AUCs) of the above indicators for predicting patient death were 0.74, 0.67, and 0.65, respectively; during the 6-month follow-up period, 22 patients were lost to follow-up, and a total of 31 patients died. Single-factor analysis revealed that compared with those of the survival group, the CCI score (13.12±5.55 vs. 9.49±3.14, P<0.01), PSI score (171.71±41.31 vs. 135.03±40.40, P<0.05), and total dose of vasoactive drugs (332.58±147.44 vs. 269.18±140.81, P<0.05) significantly differed among the three groups. Multifactor logistic regression revealed that the CCI score (OR=1.301, 95% CI: 1.147~1.476, P<0.01), PSI score (OR=1.013, 95% CI: 1.001~1.026, P<0.05), and total dose of vasoactive drugs (OR=1.004, 95% CI: 1.001~1.007, P<0.05) were independent risk factors for patient death within 6 months. The above areas under the curve (AUCs) of the indicators for predicting patient death were 0.71, 0.63, and 0.62, respectively; when patients in groups A, B, and C were followed up for 6 months, log-rank test analysis revealed that there was no significant difference in survival rates (chi-square value 4.287, P=0.12). Analysis of variance showed that there was a significant difference in PADL scores among the three groups of patients (F=5.84, P=0.004). Group A had lower scores than did group C (P=0.001), group B had lower scores than did group C (P=0.031), and group A had lower scores than did group C (P=0.031). Group A had lower scores than did group B, but the difference was not statistically significant (P=0.118); the difference in ZBI results among the three groups was statistically significant (F=4.901, P=0.009), and group A had lower scores than did group B (P=0.046). Group C scored lower than group B (P=0.017), and group C scored lower than group A, but the difference was not statistically significant (P=0.903). Since the SF-12 scale requires patients to have clear consciousness before they can complete the scale, patients in the cerebrovascular disease group (Group A) could not complete the scale. Only the scores of Groups B and C were analyzed to determine the difference between the two groups. There was no significant difference (P=0.331).
Conclusion The total dose of vasoactive drugs, the PSI score, and the number of medical consultations were found to be independent risk factors for death within 3 months after tracheotomy in critically ill elderly patients. CCI score, PSI score, and total dose of vasoactive drugs were found to be independent risk factors for death within 6 months after tracheotomy. There was no significant difference in the survival rates of patients with different types of diseases after 6 months of follow-up, but there were significant differences in the quality of life of patients and their caregiver’s burden.