Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study - 08/01/26
, Ariane Boumendil 2, Lenneke E.M. Haas 3, Marian Irazabal 4, Hans Flaatten 5, 28, Dylan W. de Lange 6, Alessandro Morandi 7, 8, Finn H. Andersen 9, 10, Guido Bertolini 11, Maurizio Cecconi 12, 13, Steffen Christensen 14, Loredana Faraldi 15, Jesper Fjølner 14, Christian Jung 16, Brian Marsh 17, Rui Moreno 18, Sandra Oeyen 19, Christina Agwald Öhman 20, Bernardo Bollen Pinto 21, Ivo W. Soliman 6, Wojciech Szczeklik 22, Andreas Valentin 23, Ximena Watson 24, Tilemachos Zaferidis 25, Bertrand Guidet 2, 26, Antonio Artigas 1, 4, 27the VIP1 study
René Schmutz, Franz Wimmer, Philipp Eller, Michael Joannidis, Pieter De Buysscher, Nikolaas De Neve, Sandra Oeyen, Walter Swinnen, Bernardo Bollen Pinto, Paul Abraham, Leila Hergafi, Joerg C. Schefold, Ewelina Biskup, Petr Piza, Ioannis Taliadoros, Jesper Fjølner, Nilanjan Dey, Christoffer Sølling, Bodil Steen Rasmussen, Steffen Christensen, Xavier Forceville, Guillaume Besch, Herve Mentec, Philippe Michel, Philippe Mateu, Philippe Michel, Lucie Vettoretti, Jeremy Bourenne, Nathalie Marin, Max Guillot, Nadia Aissaoui, Cyril Goulenok, Nathalie Thieulot-Rolin, Jonathan Messika, Lionel Lamhaut, Bertrand Guidet, Cyril Charron, Alexander Lauten, Anna Lena Sacher, Thorsten Brenner, Marcus Franz, Frank Bloos, Henning Ebelt, Stefan J. Schaller, Kristina Fuest, Christian Rabe, Thorben Dieck, Stephan Steiner, Tobias Graf, Amir M. Nia, Christian Jung, Rolf Alexander Janosi, Patrick Meybohm, Philipp Simon, Stefan Utzolino, Tim Rahmel, Eberhard Barth, Christian Jung, Michael Schuster, Zoi Aidoni, Stavros Aloizos, Polychronis Tasioudis, Kleri Lampiri, Vasiliki Zisopoulou, Ifigenia Ravani, Evmorfia Pagaki, Angela Antoniou, Theodoros A. Katsoulas, Aikaterini Kounougeri, George Marinakis, Fotios Tsimpoukas, Anastasia Spyropoulou, Paris Zygoulis, Aikaterini Kyparissi, Manish Gupta, Mohan Gurjar, Ismail M. Maji, Ivan Hayes, Brian Marsh, Yvelynne Kelly, Andrew Westbrook, Gerry Fitzpatrick, Darshana Maheshwari, Catherine Motherway, Giovanni Negri, Savino Spadaro, Guisepepe Nattino, Matteo Pedeferri, Annalisa Boscolo, Simona Rossi, Giuseppe Calicchio, Lucia Cubattoli, Gabriella Di Lascio, Maria Barbagallo, Francesco Berruto, Daniela Codazzi, Andrea Bottazzi, Paolo Fumagalli, Giancarlo Negro, Giuseppe Lupi, Flavia Savelli, Giuseppe A. Vulcano, Roberto Fumagalli, Andrea Marudi, Ugo Lefons, Rita Lembo, Maria Babini, Alessandra Paggioro, Vieri Parrini, Maria Zaccaria, Stefano Clementi, Carmelo Gigliuto, Francesca Facondini, Simonetta Pastorini, Susanna Munaron, Italo Calamai, Anna Bocchi, Adele Adorni, Maria Grazia Bocci, Andrea Cortegiani, Tariana Casalicchio, Serena Melia, Elia Graziani, Massimo Barattini, Elisabetta Brizio, Maurizio Rossi, Michael Hahn, Hans Flattens, Nicolai Kemmerer, Hans Frank Streiter, Knut Dybwik, Terje Legernaes, Pål Klepstad, Even Braut Olaussen, Knut Inge Olsen, Ole Marius Brresen, Geir Bjorsvik, Finn H. Andersen, Sameer Maini, Lutz Fehrle, Mirosław Czuczwar, Paweł Krawczyk, Mirosław Ziętkiewicz, Łukasz R. Nowak, Katarzyna Kotfis, Katarzyna Cwyl, Ryszard Gajdosz, Jowita Biernawska, Romuald Bohatyrewicz, Ryszard Gawda, Paweł Grudzień, Paweł Nasiłowski, Natalia Popek, Waldemar Cyrankiewicz, Katarzyna Wawrzyniak, Marek Wnuk, Dariusz Maciejewski, Dorota Studzińska, Maciej Żukowski, Szymon Bernas, Mariusz Piechota, Wojciech Szczeklik, Ilona Nowak-Kózka, Jakub Fronczek, Marta Serwa, Waldemar Machała, Jan Stefaniak, Maria Wujtewicz, Małgorzata Szymkowiak, Barbara Adamik, Kamil Polok, Anna Włudarczyk, Jacek Górka, Natalia Kozera, Waldemar Goździk, Nuno Catorze, Miguel Castelo Branco, Inês Barros, Nelson Barros, Andriy Krystopchuk, Teresa Honrado, Cristina Sousa, Francisco Munoz, Marta Rebelo, Rui Gomes, Jorge Nunes, Celeste Dias, Ana Margarida Fernandes, Cristina Petrisor, Bodolea Constantin, Vladislav Belskiy, Boris Boskholov, Enver Rodriguez, Sergio Rebollo, Gerardo Aguilar, Gaspar Masdeu, Marián Irazábal Jaimes, Ángela Prado Mira, Maria A. Bodi, Jesus A. Barea Mendoza, Sonia López-Cuenca, Marcela Homez Guzman, Jesús Rico-Feijoo, Mercedes Ibarz, Josep Trenado Alvarez, Rafael Kawati, Joakim Sivik, Jessica Nauska, Daniel Smole, Fredric Parenmark, Johanna Lyrén, Katalin Rockstrohm, Sara Rydén, Martin Spångfors, Morten Strinnholm, Sten Walther, Lina De Geer, Peter Nordlund, Staffan Pålsson, Harald Zetterquist, Annika Nilsson, Karin Thiringer, Mårten Jungner, Björn Bark, Berit Nordling, Hans Sköld, Camilla Brorsson, Stefan Persson, Anna Bergström, Johan Berkius, Johanna Holmström, I. van Dijk, Lenneke E.M. Haas, D. Ramnarain, Tim Jansen, Fleur Nooteboom, Peter H.J. van der Voort, Dylan de Lange, Willem Dieperink, Monique C. de Waard, Annemarie G.E. de Smet, Laura Bormans, Tom Dormans, Ged Dempsey, Shiju J. Mathew, Ashok S. Raj, Irina Grecu, Jason Cupitt, Tom Lawton, Richard Clark, Monica Popescu, Nick Spittle, Maria Faulkner, Amanda Cowton, Esme Elloway, Patricia Williams, Michael Reay, Srikanth Chukkambotla, Ravi Kumar, Nawaf Al-Subaie, Linda Kent, Tiina Tamm, Istvan Kajtor, Karen Burns, Richard Pugh, Marlies Ostermann, Elisa Kam, Helen Bowyer, Neil Smith, Maie Templeton, Jeremy Henning, Kelly Goffin, Ritoo Kapoor, Shondipon Laha, Phil Chilton, Waqas Khaliq, Alison Crayford, Samantha Coetzee, Moira Tait, Wendy Stoker, Marc Gimenez, Alan Pope, Julie Camsooksai, David Pogson, Kate Quigley, Jenny Ritzema, Anil Hormis, Carole Boulanger, M. Balasubramaniam, Luke Vamplew, Karen Burt, Daniel Martin, Irina Grecu, Jayne Craig, John Prowle, Nanci Doyle, Jonathon Shelton, Carmen Scott, Phil Donnison, Sarah Shelton, Christian Frey, Christine Ryan, Dominic Spray, Christine Ryan, Veronica Barnes, Kerry Barnes, Stephanie Ridgway, Rajnish Saha, Linda Kent, Thomas Clark, James Wood, Clare Bolger, Christopher Bassford, Amanda Cowton, John Lewandowski, Xiaobei Zhao, Sally Humphreys, Susan Dowling, Neil Richardson, Andrew Burtenshaw, Carl Stevenson, Danielle Wilcock, Yuiry Nalapko
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Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Sepsis, Very old, Intensive care, Severity of illness, Outcome, Survival, Mortality
Keywords : Medical and Health Sciences, Clinical Sciences
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Vol 10 - N° 1
Article 56- 2020 Retour au numéro
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