Outcomes in Elderly Intensive Care Unit Patients, Pulmonary Hypertension in Sickle Cell Disease, and Total Liquid Ventilation for Therapeutic Hypothermia after Cardiac Arrest in Rabbits

Abstract

The incidence of critical illness increases with age (2). Aging of the baby-boomer generation will soon lead to a larger number of elderly Americans, with those over age 85 expected to increase nearly fourfold by 2040, to nearly 15 million people. Thus, outcomes including mortality, disability, and quality of life (QOL) for critically ill elderly patients are of increasing importance. Roch and colleagues (1) evaluated mortality and QOL in a retrospective observational cohort of 299 medical intensive care unit (ICU) patients greater than 80 years old at a tertiary care university hospital in France. ICU mortality was 46% and hospital mortality was 55%. Furthermore, 1and 2-year mortality was 72 and 79%, respectively. Among hospital survivors, mortality was 53% at 2 years with a standardized mortality ratio of 2.56 (95% confidence interval, 2.08–3.12) compared with the general French population. Adjusted analysis found that severity of illness at admission and presence of a disease expected to be fatal in the next 1 or 5 years were associated with 2-year mortality, whereas preexisting functional status and admission diagnosis were not. QOL scores at a median of 63 months after discharge were significantly lower than population norms in physical health domains, whereas mental health domain scores were not reduced. Mortality rates in this single-center study were higher than those observed in similar advanced age cohorts (3), perhaps relating to local ICU practices, patient triage decisions, and end-oflife planning. Thus, these findings may lack generalizability. This study used univariate analysis to determine cofactors in the multivariable model (i.e., including factors deemed statistically significant, which may be “noise” because of the large number of risk factors analyzed), which increases the risk of overfitting of the model and may distort study conclusions. Nevertheless, this study suggests a substantial mortality risk in critically ill patients over age 80. QOL may be an insensitive instrument to detect disability after critical illness, as a large cohort study of similarly aged Medicare patients found marked cognitive and functional impairment after severe sepsis (4). Future prospective studies are needed into predictors of mortality and morbidity in this growing population of the oldest-old.