Age and Ageing, Vol 28, 253-256, Copyright © 1999 by British Geriatrics Society
N Van Den Noortgate, D Vogelaers, M Afschrift and F Colardyn
OBJECTIVES: To evaluate outcome and risk factors, particularly the Acute
Physiology and Chronic Health Evaluation (APACHE) II scoring system, for
in-hospital mortality in very elderly patients after admission to an
intensive care unit (ICU). METHODS: Retrospective chart review of patients
> or =85 years admitted to the ICU. We recorded age, sex, previous
medical history, primary diagnosis, date of admission and discharge or
death, APACHE II score on admission, use of mechanical ventilation and
inotropics, and complications during ICU admission. RESULTS: 104 patients
> or =85 years (1.3% of all ICU admissions) were studied. The ICU and
in-hospital mortality rates for these patients were 22 and 36%
respectively. Factors correlated with a greater in- hospital mortality
were: an admission diagnosis of acute respiratory failure (chi2; P =
0.007), the use of mechanical ventilation (chi2; P = 0.00005) and inotropes
(chi2; P = 0.00001), complications during ICU admission (chi2; P = 0.004),
in particular acute renal failure (chi2; P = 0.005), and an APACHE II score
> or =25 (chi2; P = 0.001). The APACHE II scoring system and the use of
inotropes were independently correlated with mortality. CONCLUSION: ICU and
in-hospital mortality are higher in very elderly patients, particularly in
those with an APACHE II score > or =25. The most important predictors of
mortality are the use of inotropes and the severity of the acute illness.
ARTICLES
Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality
Department of Gerontology and Geriatrics, University Hospital Gent, Belgium.
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