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[Diagnosis and clinical results in elderly patients in an internal medicine intensive care unit]
L Mayerhofer1, R W Kurz, R Schuster
11. Medizinische Abteilung, Sozialmedizinisches Zentrum Ost-Donauspital Wien.
Objective:
To ascertain prospectively whether age is an independent prognostic factor for patients in a medical intensive care unit (MICU).
Patients And Methods:
The data recorded prospectively for all patients admitted to a MICU between October 1994 and April 1996 were analysed with regard to demographic items, admission diagnosis. APACHE II score, days spent in the MICU and mortality rate. The data were arranged by age group and admission diagnosis (APACHE II score).
Results:
753 patients were admitted, 423 aged 65 or over (56.2%). Analysis of subgroups among the latter revealed a significant decrease in cardiovascular admission diagnoses with increasing age (65-74 years: 59%; 75-84: 55%; 85 or over: 32%), while the opposite trend pertained for pulmonary disease (65-74 years: 10%; 75-84%: 19%; 85 or over: 21%). There was a significant correlation for the total collective between mortality rate and severity of the disease on admission to the MICU (APACHE II score; P < 0.05). Those 65 years or older had a higher APACHE II score (17.4 vs 12.0; P < 0.05) and thus a higher mortality rate than the younger patients (25% vs > 12%; P < 0.01).
Conclusion:
Many of the patients admitted to a MICU were aged over 65 years. The incidence of cardiovascular ailments on admission decreased with increasing age, while the opposite trend was true for pulmonary disease. There was no difference in mortality rate between different age groups given similar disease severity.
Insights
Age is not an independent prognostic factor in the medical intensive care unit (MICU). While older patients (65+) have higher disease severity scores and mortality, outcomes are similar when disease severity is comparable across age groups.
Area of Science:
- Critical Care Medicine
- Geriatric Medicine
- Prognostic Factor Analysis
Context:
- Medical Intensive Care Units (MICUs) frequently admit elderly patients.
- Understanding prognostic factors in this demographic is crucial for patient management.
Purpose:
- To prospectively evaluate if advanced age is an independent prognostic factor for patients in a MICU.
- To analyze the relationship between age, admission diagnosis, disease severity (APACHE II score), and mortality.
Summary:
- A prospective study of 753 MICU patients (423 aged 65+) found decreasing cardiovascular admissions and increasing pulmonary disease admissions with advanced age.
- Older patients (65+) had higher APACHE II scores and mortality rates compared to younger patients.
- However, when disease severity was similar, there was no significant difference in mortality rates between age groups.
Impact:
- This study suggests that age itself may not be an independent predictor of mortality in the MICU.
- Disease severity, as indicated by the APACHE II score, is a more critical determinant of outcomes.
- Findings emphasize the importance of considering disease severity over age alone when assessing prognosis in critically ill elderly patients.