Propensity-adjusted comparison of mortality of elderly versus very elderly ventilated patients

Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W. Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M. Maggiore, Andrew Bersten, Malte Kelm, Pravin AminNahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W. De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective anal-ysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65–79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P <.001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P <.001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16–1.49], P <.001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified.

Original languageEnglish (US)
Pages (from-to)814-821
Number of pages8
JournalRespiratory care
Volume66
Issue number5
DOIs
StatePublished - May 1 2021

Keywords

  • Critically ill
  • Elderly subjects
  • ICU
  • Mechan-ical ventilation
  • Risk scores
  • Risk stratification

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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