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Sepsis at ICU admission does not decrease 30-day survival in very old patients

2020-12-01Artigo científico Acesso aberto
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dc.contributor.authorIbarz, Mercedes
dc.contributor.authorBoumendil, Ariane
dc.contributor.authorHaas, Lenneke E.M.
dc.contributor.authorIrazabal, Marian
dc.contributor.authorFlaatten, Hans
dc.contributor.authorde Lange, Dylan W.
dc.contributor.authorMorandi, Alessandro
dc.contributor.authorAndersen, Finn H.
dc.contributor.authorBertolini, Guido
dc.contributor.authorCecconi, Maurizio
dc.contributor.authorChristensen, Steffen
dc.contributor.authorFaraldi, Loredana
dc.contributor.authorFjølner, Jesper
dc.contributor.authorJung, Christian
dc.contributor.authorMarsh, Brian
dc.contributor.authorMoreno, Rui
dc.contributor.authorOeyen, Sandra
dc.contributor.authorÖhman, Christina Agwald
dc.contributor.authorBollen Pinto, Bernardo
dc.contributor.authorSoliman, Ivo W.
dc.contributor.authorSzczeklik, Wojciech
dc.contributor.authorValentin, Andreas
dc.contributor.authorWatson, Ximena
dc.contributor.authorZaferidis, Tilemachos
dc.contributor.authorZafeiridis, Tilemachos
dc.contributor.authorGuidet, Bertrand
dc.contributor.authorArtigas, Antonio
dc.contributor.authorSchmutz, René
dc.contributor.authorWimmer, Franz
dc.contributor.authorEller, Philipp
dc.contributor.authorJoannidis, Michael
dc.contributor.authorDe Buysscher, Pieter
dc.contributor.authorDe Neve, Nikolaas
dc.contributor.authorOeyen, Sandra
dc.contributor.authorSwinnen, Walter
dc.contributor.authorBollen Pinto, Bernardo
dc.contributor.authorAbraham, Paul
dc.contributor.authorHergafi, Leila
dc.contributor.authorSchefold, Joerg C.
dc.contributor.authorBiskup, Ewelina
dc.contributor.authorPiza, Petr
dc.contributor.authorTaliadoros, Ioannis
dc.contributor.authorFjølner, Jesper
dc.contributor.authorDey, Nilanjan
dc.contributor.authorSølling, Christoffer
dc.contributor.authorRasmussen, Bodil Steen
dc.contributor.authorChristensen, Steffen
dc.contributor.authorForceville, Xavier
dc.contributor.authorBesch, Guillaume
dc.contributor.authorMentec, Herve
dc.contributor.authorMichel, Philippe
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer Verlag
dc.date.accessioned2020-09-15T22:46:23Z
dc.date.available2020-09-15T22:46:23Z
dc.date.issued2020-12-01
dc.description.abstractBackground: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1236567
dc.identifier.doi10.1186/s13613-020-00672-w
dc.identifier.issn2110-5820
dc.identifier.otherPURE: 19845678
dc.identifier.otherPURE UUID: 53280e6c-b66f-41a6-973c-610214177690
dc.identifier.otherScopus: 85090141604
dc.identifier.otherPubMed: 32406016
dc.identifier.otherPubMedCentral: PMC7221097
dc.identifier.otherWOS: 000536278100001
dc.identifier.urihttp://hdl.handle.net/10362/104137
dc.identifier.urlhttps://www.scopus.com/pages/publications/85090141604
dc.language.isoeng
dc.peerreviewedyes
dc.subjectIntensive care
dc.subjectMortality
dc.subjectOutcome
dc.subjectSepsis
dc.subjectSeverity of illness
dc.subjectSurvival
dc.subjectVery old
dc.subjectCritical Care and Intensive Care Medicine
dc.titleSepsis at ICU admission does not decrease 30-day survival in very old patientsen
dc.title.subtitlea post-hoc analysis of the VIP1 multinational cohort studyen
dc.typejournal article
degois.publication.issue1
degois.publication.titleAnnals of Intensive Care
degois.publication.volume10
dspace.entity.typePublication
person.familyNameZafeiridis
person.givenNameTilemachos
person.identifier.orcid0000-0001-5020-312X
rcaap.rightsopenAccess
relation.isAuthorOfPublication238e23ee-a9f7-42ef-8d52-6141abcebafe
relation.isAuthorOfPublication.latestForDiscovery238e23ee-a9f7-42ef-8d52-6141abcebafe

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