Factors affecting the outcome of older adults followed in the intensive care unit according to age stages
Mortality in older adults in ICU
Keywords:
mortality, APACHE II, red cell distribution width, geriatrics, intensive care unitAbstract
Background/Aim: Increased frailty with age along with an increase in comorbidities heighten mortality in intensive care units. According to the World Health Organization, old age is divided into three stages: 65–74 years, 75–84 years, and 85 years and older. The lengthened human lifespan leads to a growth in the number of elderly patients in intensive care units, and the need to know the factors associated with prognosis in the three stages of old age. We aimed to define factors affecting mortality in these three stages of aging and the factors that can help predict prognoses.
Methods: In this retrospective cohort, data of patients over the age of 65 who were admitted to the intensive care unit of Bolu Izzet Baysal State Hospital between January 2016 and December 2020 were recorded using the hospital's automation system. Demographic data, blood tests, diagnoses and inflammatory biomarkers, such as RDW, NLR, and CAR were recorded. The data were analyzed using SPSS, and P<0.05 was considered significant.
Results: In this study, 46.2% of the 1566 patients died. The most common diagnosis for admission to the intensive care unit was sepsis, and the most common comorbidity was hypertension. While neurological impairment (P<0.001), malignancy (P=0.006), and cardiac disease (P=0.004) were associated with mortality in all three stages of old age, chronic obstructive pulmonary disease was associated with mortality in the 85 years and older age group (P=0.011) and diabetes in those aged 65–74 years and 75–84 years. The APACHE II score (P<0.001) and red cell distribution width (P<0.001) were highly effective in predicting prognoses in all three stages of old age.
Conclusion: In examining the factors associated with mortality in older age intensive care unit patients, we found that the APACHE II score and red cell distribution width were effective in establishing prognoses for all age groups.
Downloads
References
Akin S, Gündogan K, Coskun R, Güven M, Murat Sungur M, Civan Yüksel R, et al. Critically ill elderly patient mortality: Is age a risk factor? Journal of Medical and Surgical Intensive Care Medicine 2014;5(2):26–9. doi: 10.5152/dcbybd.2014.667 DOI: https://doi.org/10.5152/dcbybd.2014.667
Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today’s critically ill patients. Critical Care Medicine 2006;34(5):1297–310. doi: 10.1097/01.CCM.0000215112.84523.F0. DOI: https://doi.org/10.1097/01.CCM.0000215112.84523.F0
Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Annals of Medicine 2011;43(1):40–6. doi: 10.3109/07853890.2010.521766 DOI: https://doi.org/10.3109/07853890.2010.521766
Loveday S, Sinclair L, Badrick T. Does the addition of RDW improve current ICU scoring systems? Clinical Biochemistry 2015;48(9):569–74. doi: 10.1016/j.clinbiochem.2015.04.002 DOI: https://doi.org/10.1016/j.clinbiochem.2015.04.002
Jandaghian S, Vaezi A, Manteghinejad A, Nasirian M, Vaseghi G, Javanmard SH. Red Blood Cell Distribution Width (RDW) as a Predictor of In-Hospital Mortality in COVID-19 Patients; a Cross Sectional Study. Archives of Academic Emergency Medicine 2021;9(1):1–8. doi: 10.22037/aaem.v9i1.1325
Tekin CS, Kara F. Aging in the World and Turkey. Journal of the International Scientific Researches 2018;3(1):219–29. https://doi.org/10.21733/ibad.370584 DOI: https://doi.org/10.21733/ibad.370584
Turkish Statistical Institute, Elderly Statistics, 2021. [Internet]Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2021-45636. Accessed: 16.12.2022
Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society 2003;51(4):451–8. doi: 10.1046/j.1532-5415.2003.51152.x DOI: https://doi.org/10.1046/j.1532-5415.2003.51152.x
Englert NC, Ross C. The Older Adult Experiencing Sepsis. Critical Care Nursing Quarterly 2015;38(2):175–81. doi: 10.1097/CNQ.0000000000000059 DOI: https://doi.org/10.1097/CNQ.0000000000000059
Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B. Should elderly patients be admitted to the intensive care unit? Intensive Care Medicine 2007;33(7):1252–62. doi: 10.1007/s00134-007-0621-3. DOI: https://doi.org/10.1007/s00134-007-0621-3
Guan Y, Yin R, Zheng P, Liu C, Wei B. Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching. Disease Markers 2022;2694499:1–13. doi: 10.1155/2022/2694499 DOI: https://doi.org/10.1155/2022/2694499
Cunha C, Santos K, Varea E, Wiegert M, Oliveira LC De. Clinical Relevance and Prognostic Value of Inflammatory Biomarkers: A prospective Study in Terminal Cancer Patients Receiving Palliative Care. Journal of Pain and Symptom Management 2021;62(5):978–86. doi: 10.1016/j.jpainsymman.2021.04.009. Epub 2021 Apr 22. DOI: https://doi.org/10.1016/j.jpainsymman.2021.04.009
Deniz M, Ozgun P, Ozdemir E. Relationships between RDW, NLR, CAR, and APACHE II scores in the context of predicting the prognosis and mortality in ICU patients. European Review for Medical and Pharmacological Sciences 2022;26(12):4258–67. doi: 10.26355/eurrev_202206_29063.
Hu Y, Huang K, Ji Z, Wang S. High neutrophil-to-lymphocyte ratio is associated with poor clinical outcome in patients with critically ill stroke. Minerva Anestesiologica 2020;86(9):939–47. doi: 10.23736/S0375-9393.20.14310-4 DOI: https://doi.org/10.23736/S0375-9393.20.14310-4
Karakoyun I, Colak A, Turken M, et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. International Immunopharmacology 2021;91:107285. doi: 10.1016/j.intimp.2020.107285 DOI: https://doi.org/10.1016/j.intimp.2020.107285
Kalyon S, Fethi G, Simsek F, Adas M. Relationships of the neutrophil – lymphocyte and CRP – albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19. Journal of International Medical Research 2021;49(9):1–10. doi: 10.1177/03000605211046112 DOI: https://doi.org/10.1177/03000605211046112
Acehan S, Cem I, Kaya A, Unlu N. C-reactive protein to albumin ratio is associated with increased risk of mortality in COVID-19 pneumonia patients. Cukurova Medical Journal 2021;46(4):1449–58. doi: 10.17826/cumj.977050 DOI: https://doi.org/10.17826/cumj.977050
Yan L, Hu Z. Red Blood Cell Distribution Width, Neutrophil-to-Lymphocyte Ratio, and In-Hospital Mortality in Dyspneic Patients Admitted to the Emergency Department. Disease Markers 2020;8839506:1–5. doi: 10.1155/2020/8839506 DOI: https://doi.org/10.1155/2020/8839506
Ayranci MK, Küçükceran K, Dundar ZD. NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients. The American Journal of Emergency Medicine 2021;44:50–5. doi: 10.1016/j.ajem.2021.01.053. DOI: https://doi.org/10.1016/j.ajem.2021.01.053
Akilli NB, Mutlu H, Günaydın YK, Koylu R, Oktar L, Cander B. Neutrophil-Lymphocyte Ratio as a Mortality Predictive Parameter In Patıents Wıth Out-of-Hospital Cardiac Arrest. Eurasian Journal of Critical Care 2010;3(1):15–20.
Simpson G, Saunders R, Wilson J, Magee C. The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group. European Journal of Trauma and Emergency Surgery 2018;44(6):877–82. doi: 10.1007/s00068-017-0869-4. DOI: https://doi.org/10.1007/s00068-017-0869-4
Downloads
- 138 264
Published
Issue
Section
How to Cite
License
Copyright (c) 2023 Mustafa Deniz, Pınar Ayvat
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.