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[Age as a prognostic factor in intensive care].

J Latour Pérez1, V López Camps, M Rodríguez Serra

  • 1Unidad de Cuidados Intensivos, Hospital General d'Elx, Elche, Alicante.

Medicina Clinica
|February 10, 1990
PubMed
Summary

Older patients (over 65) face higher mortality in intensive care units, independent of illness severity. Age significantly impacts survival, especially in less severe cases or with acute myocardial infarction.

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Area of Science:

  • Critical Care Medicine
  • Geriatric Medicine
  • Epidemiology

Context:

  • Intensive care units (ICUs) manage critically ill patients with varying prognoses.
  • Understanding factors influencing ICU outcomes is crucial for resource allocation and patient care.
  • Age is a recognized factor, but its independent prognostic value alongside severity and therapeutic effort requires clarification.

Purpose:

  • To determine the prognostic impact of patient age in critical care settings.
  • To investigate the association between age, initial illness severity (SAPS index), and therapeutic effort (TISS index).
  • To analyze how age influences mortality risk, considering other clinical factors.

Summary:

  • A study of 1,102 adult ICU patients revealed that older patients (>65 years) had significantly higher mean SAPS scores and mortality rates (OR=1.99).

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  • Age demonstrated a dose-response relationship with mortality, persisting even after controlling for initial illness severity (p<0.0001).
  • The impact of age on mortality was more pronounced in patients with lower SAPS scores (OR=2.94) and those admitted for acute myocardial infarction (OR=3.28).
  • Older patients exhibited lower TISS/SAPS ratios and shorter ICU stays, suggesting reduced therapeutic intensity, yet this did not fully explain their excess mortality (adjusted OR=2.42).

    • Impact:

    • This research highlights age as a critical independent prognostic factor in ICU patients.
    • Findings suggest that age-related mortality risk may be underestimated when solely relying on severity scores.
    • The study underscores the need for age-specific considerations in critical care management and prognosis assessment.