Long-Term Outcomes After ICU Admission Triage in Octogenarians
Long-Term Outcomes After ICU Admission Triage in Octogenarians
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DOI：
10.1097/ccm.0000000000002098
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发表时间：
2017-04-01
影响因子：
8.8
通讯作者：
Kvale, Reidar
中科院分区：
文献类型：
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作者：
Andersen, Finn H.;Flaatten, Hans;Kvale, Reidar
目的：探讨老年ICU患者的入院分诊及转归。设计：多中心前瞻性观察研究。环境：挪威的三家非大学医院和三家大学医院。患者：2013年11月至2014年10月转诊至ICU的80岁及以上患者。干预措施:没有。测量结果及主要结果：355例患者中，105例（29.6%）拒绝ICU治疗。被认为“太病/太老”的患者拒绝ICU的危险因素是高龄和功能低下。被认为“太好”的患者拒绝ICU的危险因素为高龄、男性、大学住院、合并症和简化急性生理评分3分低。ICU总生存率为71.6%。住院患者的住院和1年生存率分别为56.0%和40.0%，非住院患者认为太好患者的住院和1年生存率分别为65.2%和50.0%，太病/老患者的住院和1年生存率分别为32.7%和11.5%。经校正的Kaplan-Meier曲线显示，被认为太病/太老的非住院患者的生存率明显低于被认为太好的非住院患者。在随访中，分诊患者在自我护理、日常护理、焦虑和抑郁方面的健康相关生活质量低于年龄和性别匹配的对照组，EuroQol视觉模拟量表得分也较低。结论：总体而言，29.6%的患者拒绝ICU治疗。调整后的生存分析显示，住进ICU的80多岁老人的生存率明显高于那些被认为病得太重/太老的未住进ICU的患者，这表明住进ICU有好处。总体而言，分诊患者的随访显示，与年龄和性别匹配的对照人群相比，与健康相关的生活质量较低。
Objective: To describe ICU admission triage and outcomes in octogenarians.Design: Multicenter prospective observational study.Setting: Three nonuniversity hospitals and three university hospitals in Norway.Patients: Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.Interventions: None.Measurements and Main Results: Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered "too ill/old" were advanced age and low functional status. Risk factors for ICU refusal in patients considered "too well" were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age-and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores.Conclusions: Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age-and sex-matched control population.