Sepsis at ICU admission does not decrease 30-day survival in very old patients
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...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:252603 |
| Acceso en línea: | https://ddd.uab.cat/record/252603 https://dx.doi.org/urn:doi:10.1186/s13613-020-00672-w |
| Access Level: | acceso abierto |
| Palabra clave: | Sepsis Very old Intensive care Severity of illness Outcome Survival Mortality |
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oai:ddd.uab.cat:252603 |
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España |
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| dc.title.none.fl_str_mv |
Sepsis at ICU admission does not decrease 30-day survival in very old patients a post-hoc analysis of the VIP1 multinational cohort study |
| title |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| spellingShingle |
Sepsis at ICU admission does not decrease 30-day survival in very old patients Ibarz, Mercedes|||0000-0003-2908-0748 Sepsis Very old Intensive care Severity of illness Outcome Survival Mortality |
| title_short |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| title_full |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| title_fullStr |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| title_full_unstemmed |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| title_sort |
Sepsis at ICU admission does not decrease 30-day survival in very old patients |
| dc.creator.none.fl_str_mv |
Ibarz, Mercedes|||0000-0003-2908-0748 Boumendil, Ariane Haas, Lenneke E. M. Irazabal, Marian Flaatten, Hans|||0000-0001-9186-3482 De Lange, Dylan W..|||0000-0002-0191-7270 Morandi, Alessandro Andersen, Finn H.|||0000-0003-3775-7325 Bertolini, Guido Cecconi, Maurizio|||0000-0002-4376-6538 Christensen, Steffen Faraldi, Loredana Fjølner, Jesper|||0000-0003-3371-0503 Jung, Christian|||0000-0001-8325-250X Marsh, Brian|||0000-0002-6711-6628 Moreno, Rui|||0000-0002-9795-8316 Oeyen, Sandra|||0000-0001-6880-7167 Öhman, Christina Agwald Bollen Pinto, Bernardo|||0000-0002-1281-543X Soliman, Ivo W. Szczeklik, Wojciech|||0000-0002-1349-1123 Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand|||0000-0002-7643-6770 Artigas Raventós, Antoni|||0000-0002-8029-1017 |
| author |
Ibarz, Mercedes|||0000-0003-2908-0748 |
| author_facet |
Ibarz, Mercedes|||0000-0003-2908-0748 Boumendil, Ariane Haas, Lenneke E. M. Irazabal, Marian Flaatten, Hans|||0000-0001-9186-3482 De Lange, Dylan W..|||0000-0002-0191-7270 Morandi, Alessandro Andersen, Finn H.|||0000-0003-3775-7325 Bertolini, Guido Cecconi, Maurizio|||0000-0002-4376-6538 Christensen, Steffen Faraldi, Loredana Fjølner, Jesper|||0000-0003-3371-0503 Jung, Christian|||0000-0001-8325-250X Marsh, Brian|||0000-0002-6711-6628 Moreno, Rui|||0000-0002-9795-8316 Oeyen, Sandra|||0000-0001-6880-7167 Öhman, Christina Agwald Bollen Pinto, Bernardo|||0000-0002-1281-543X Soliman, Ivo W. Szczeklik, Wojciech|||0000-0002-1349-1123 Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand|||0000-0002-7643-6770 Artigas Raventós, Antoni|||0000-0002-8029-1017 |
| author_role |
author |
| author2 |
Boumendil, Ariane Haas, Lenneke E. M. Irazabal, Marian Flaatten, Hans|||0000-0001-9186-3482 De Lange, Dylan W..|||0000-0002-0191-7270 Morandi, Alessandro Andersen, Finn H.|||0000-0003-3775-7325 Bertolini, Guido Cecconi, Maurizio|||0000-0002-4376-6538 Christensen, Steffen Faraldi, Loredana Fjølner, Jesper|||0000-0003-3371-0503 Jung, Christian|||0000-0001-8325-250X Marsh, Brian|||0000-0002-6711-6628 Moreno, Rui|||0000-0002-9795-8316 Oeyen, Sandra|||0000-0001-6880-7167 Öhman, Christina Agwald Bollen Pinto, Bernardo|||0000-0002-1281-543X Soliman, Ivo W. Szczeklik, Wojciech|||0000-0002-1349-1123 Valentin, Andreas Watson, Ximena Zaferidis, Tilemachos Guidet, Bertrand|||0000-0002-7643-6770 Artigas Raventós, Antoni|||0000-0002-8029-1017 |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Universitat Autònoma de Barcelona |
| dc.subject.none.fl_str_mv |
Sepsis Very old Intensive care Severity of illness Outcome Survival Mortality |
| topic |
Sepsis Very old Intensive care Severity of illness Outcome Survival Mortality |
| description |
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. 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]. 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 |
| publishDate |
2020 |
| dc.date.none.fl_str_mv |
2 2020-01-01 2020 2020-01-01 |
| dc.type.none.fl_str_mv |
Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://ddd.uab.cat/record/252603 https://dx.doi.org/urn:doi:10.1186/s13613-020-00672-w |
| url |
https://ddd.uab.cat/record/252603 https://dx.doi.org/urn:doi:10.1186/s13613-020-00672-w |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
| dc.rights.openaire.fl_str_mv |
info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf |
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reponame:Dipòsit Digital de Documents de la UAB instname:Universitat Autònoma de Barcelona |
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Universitat Autònoma de Barcelona |
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Dipòsit Digital de Documents de la UAB |
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Dipòsit Digital de Documents de la UAB |
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1869413271374659584 |
| spelling |
Sepsis at ICU admission does not decrease 30-day survival in very old patientsa post-hoc analysis of the VIP1 multinational cohort studyIbarz, Mercedes|||0000-0003-2908-0748Boumendil, ArianeHaas, Lenneke E. M.Irazabal, MarianFlaatten, Hans|||0000-0001-9186-3482De Lange, Dylan W..|||0000-0002-0191-7270Morandi, AlessandroAndersen, Finn H.|||0000-0003-3775-7325Bertolini, GuidoCecconi, Maurizio|||0000-0002-4376-6538Christensen, SteffenFaraldi, LoredanaFjølner, Jesper|||0000-0003-3371-0503Jung, Christian|||0000-0001-8325-250XMarsh, Brian|||0000-0002-6711-6628Moreno, Rui|||0000-0002-9795-8316Oeyen, Sandra|||0000-0001-6880-7167Öhman, Christina AgwaldBollen Pinto, Bernardo|||0000-0002-1281-543XSoliman, Ivo W.Szczeklik, Wojciech|||0000-0002-1349-1123Valentin, AndreasWatson, XimenaZaferidis, TilemachosGuidet, Bertrand|||0000-0002-7643-6770Artigas Raventós, Antoni|||0000-0002-8029-1017SepsisVery oldIntensive careSeverity of illnessOutcomeSurvivalMortalityThe 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. 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]. 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 survivalUniversitat Autònoma de Barcelona 22020-01-0120202020-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/252603https://dx.doi.org/urn:doi:10.1186/s13613-020-00672-wreponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2526032026-06-06T12:50:31Z |
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15,198674 |