RESUMEN
BACKGROUND AND OBJECTIVES: The care of older patients in intensive care units (ICU) is becoming more frequent. To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality. PATIENTS AND METHODS: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression. RESULTS: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge. An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality. CONCLUSIONS: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis.
Asunto(s)
Lesión Renal Aguda , Unidades de Cuidados Intensivos , Lesión Renal Aguda/terapia , Anciano , Anciano de 80 o más Años , Estudios Transversales , Mortalidad Hospitalaria , Hospitalización , Humanos , Estudios RetrospectivosRESUMEN
Antecedentes y objetivos: Cada vez es más frecuente la asistencia de los pacientes de más edad en las unidades de cuidados intensivos (UCI).Describir las características de los pacientes mayores ingresados en la UCI y analizar los factores asociados a la mortalidad.Pacientes y métodos: Estudio transversal retrospectivo, con pacientes ≥80 años, admitidos en la UCI del Hospital Universitario Rey Juan Carlos, desde marzo 2012 a diciembre 2018. Se recogieron variables demográficas, comorbilidades y mortalidad en la UCI, en hospital y al año, analizadas mediante análisis univariante y regresión logística binaria.Resultados: Seiscientos veinte pacientes, edad media 83,6 años (DE: 3,25), el 31% precisó ventilación mecánica invasiva (VMI), el 25% vasopresores y el 29% terapia renal sustitutiva (TRS) por fracaso renal agudo (FRA). El 60% fueron ingresos de origen médico. La mortalidad intrahospitalaria fue de 156 pacientes (25%), 91 fallecieron en la UCI y 65 en planta, siendo las estancias en la UCI más breves de los supervivientes (2,72; DE: 0,22) respecto a los fallecidos (3,74; DE: 0,38), con diferencias estadísticamente significativa. El 63% permanecieron vivos un año después del alta de la UCI.Se obtuvo un modelo explicativo de mortalidad en la UCI mediante regresión logística que incluía los siguientes factores: VMI (OR: 5,78; IC 95%: 2,73-12,22), vasopresores (OR: 2,54; IC 95%: 1,24-5,19), FRA/TRS (OR: 2,69; IC 95%: 1.35-5.35), ingreso médico (OR: 2,88; IC 95%: 1,40-5,92), ingreso urgente (OR: 2,33; IC 95%: 1,30-4,18) y limitación de soporte vital (LTSV) (OR: 47,35; IC 95%: 22,96-97,68). Los días en la UCI (OR: 0,93; IC 95%: 0,87-0,99) se relacionarían inversamente con la mortalidad.Conclusiones: En los pacientes mayores no hay un aumento de la mortalidad con una supervivencia al año >63%. La necesidad de VMI, el uso de fármacos vasopresores y FRA/TRS, fueron factores asociados a la mortalidad en el análisis multivariante. (AU)
Background and objectives: The care of older patients in intensive care units (ICU) is becoming more frequent.To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality.Patients and methods: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression.Results: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge.An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality.Conclusions: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis. (AU)