Long term outcomes for elderly patients after emergency intensive care admission: A cohort study.

Abstract

BackgroundElderly patients (≥ 80 years of age) surviving an episode of critical illness suffer long-term morbidity and risk of mortality. Identifying high risk groups could assist in informing discussions with patients and families.AimTo determine factors associated with long-term survival following ICU admission.DesignA cohort study of patients aged ≥ 80 years of age admitted to the ICU as an emergency.MethodsPatients admitted from January 2010 to December 2018 were included in the study. Primary outcome was five year survival. Mortality was assessed using a multivariable flexible parametric survival analysis adjusted for demographics, and clinically relevant covariates.ResultsThere were 828 patients. Mean age was 84 years (SD 3.2) and 419 (51%) were male. Patients were categorised into medical (423 (51%)) and surgical (405 (49%)) admissions. Adjusted hazard ratios (aHR) for mortality were highest for serum lactate (>8 mmol/l aHR 2.56 (C.I. 1.79-3.67)), lowest systolic blood pressure ( 8 mmol/l respectively). Relative survival for medical patients was below that expected for the general population for the duration of the study.ConclusionOverall five-year survival was 27%. For medical and surgical patients it was 19% and 35% respectively. Survival at 30 days and one year was 61% and 46%. The presence of features of circulatory shock predicted poor short and long term survival.