TY - JOUR
T1 - Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Beil, Michael
AU - Muessig, Johanna M.
AU - Rahmel, Tim
AU - Graf, Tobias
AU - Meybohm, Patrick
AU - Schaller, Stefan J.
AU - Allgäuer, Sebastian
AU - Franz, Marcus
AU - Westphal, Julian Georg
AU - Barth, Eberhard
AU - Ebelt, Henning
AU - Fuest, Kristina
AU - Horacek, Michael
AU - Schuster, Michael
AU - Dubler, Simon
AU - Schering, Stefan
AU - Wolff, Georg
AU - Steiner, Stephan
AU - Rabe, Christian
AU - Dieck, Thorben
AU - Lauten, Alexander
AU - Sacher, Anne Lena
AU - Brenner, Thorsten
AU - Bloos, Frank
AU - Jánosi, Rolf A.
AU - Simon, Philipp
AU - Utzolino, Stefan
AU - Kelm, Malte
AU - De Lange, Dylan W.
AU - Guidet, Bertrand
AU - Flaatten, Hans
AU - Jung, Christian
N1 - Funding Information:
The authors thank the steering committee of the VIP-1 and VIP-2 study for their support: Hans Flaatten, principal Investigator (Norway), Bertrand Guidet (France), Dylan de Lange (The Netherlands), Antonio Artigas (Spain), Finn Andersen (Norway), Carol Boulanger (UK), Ariane Boumendil (France), Maurizio Cecconi (Italy), Jesper Fj?lner (Denmark), Brian Marsh (Ireland), Alessandro Morandi (Italy), Rui Moreno (Portugal), Sandra Oyen (Belgium), Joerg Schefold (Switzerland), Ivo Soliman (The Netherlands), Wojciech Szczeklik (Poland), Michael Joannidis (Austria), Sten Walther (Sweden), Ximena Watson (UK), Tilemachos Zafeiridis (Greece), Yuriy Nalapko (Ukranian).
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. Methods: German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. Results: 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82–88] vs. 83 [IQR 81–86] years p <.001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p <.0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04–1.46 p =.02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p <.001) and length of stay (144 [IQR 72–293] versus 96 [IQR 47.25–231.5] hours, p =.026). Conclusion: In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
AB - Purpose: The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. Methods: German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. Results: 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82–88] vs. 83 [IQR 81–86] years p <.001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p <.0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04–1.46 p =.02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p <.001) and length of stay (144 [IQR 72–293] versus 96 [IQR 47.25–231.5] hours, p =.026). Conclusion: In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
UR - http://www.scopus.com/inward/record.url?scp=85089012609&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2020.07.024
DO - 10.1016/j.jcrc.2020.07.024
M3 - Journal articles
C2 - 32769006
AN - SCOPUS:85089012609
SN - 0883-9441
VL - 60
SP - 58
EP - 63
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -
