[The risk factors in elderly intensive care unit (ICU) patients admitted after non-traumatic haemorrhagic shock]

Haemorrhage into the digestive tract lumen in elderly patients leads directly to multiorgan instability and failure. Analysis of 68 ICU patients, treated in 2007-2008 proved interdependence between presenting co-existing diseases, including reduction of vital organ reserve, and multiorgan dysfunction. Each patient was evaluated consecutively according to four commonly accepted severity-of-illness scoring systems (severity models): SAPS2, LODS, MODS and POSSUM. The assessment was displayed in numbers (predicted death rate, PDR) and in binary system of survivors (60%) and non-survivors (40%). The last group was divided into two subgroups: a/. those, who survived (their average PDR calculated in SAPS 2 on admittance was 22.3 vs after surgery on ICU was 25.1, and respectively computed in LODS on admittance was 17.4 vs after surgery on ICU was 21.4), and b/. those, who died shortly after hospital admittance, or following surgery in the ICU (their average PDR calculated on admittance in SAPS2 was 34.8 vs after surgery on ICU was 62.3, and respectively computed in LODS on admittance was 30.0 vs after surgery on ICU was 57.2). In POSSUM average PDR calculated for survivors was 61.6 vs for 85.4 in non-survivors. The difference was also noticed during collecting points in severity scoring systems: in MODS for non-survivors (3.3 on admittance vs 7.5 calculated in ICU after surgery), and in LODS (5.8 vs 9.5, respectively), p<0.001. The main risk factors were systolic blood pressure < 90 mmHg, HR > 140/min, Glasgow Coma Scale < 12, urine output < 20ml/ h, Hb < 8.5 g/L, creatinine > 350 micromol/l, paO2 < 60 mmHg, INR > 2,2, catecholamine i.v. administration > 1 h, mechanical ventilation > 48h, surgery < 2h following patients hospital admittance. In non-survivor group there were more than two co-existing diseases in the 3rd or 4th degree of advancement (p<0.004).