Abstract
BackgroundPoor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older. In the subgroup of very old ICU patients, the ability to recover from critical illness varies irrespective of age. To assess the predictive ability of PFS also among the patients aged 85 or older we set out the current study.MethodsIn this nationwide observational registry study based on the Finnish Intensive Care Consortium database, we analysed data of patients aged 85 years or over treated in ICUs between May 2012 and December 2015. We defined PFS as good for patients who had been independent in activities of daily living (ADL) and able to climb stairs and as poor for those who were dependent on help or unable to climb stairs.To assess patients’ functional outcome one year after ICU admission, we created a functional status score (FSS) based on how many out of five physical activities (getting out of bed, moving indoors, dressing, climbing stairs, and walking 400 m) the patient could manage. We also assessed the patients’ ability to return to their previous type of accommodation.ResultsOverall, 2037 (3.3% of all adult ICU patients) patients were 85 years old or older. The average age of the study population was 87 years. Data on PFS were available for 1446 (71.0%) patients (good for 48.8% and poor for 51.2%). The one-year mortalities of patients with good and those with poor PFS were 29.2% and 50.1%, respectively, p < 0.001. Poor PFS increased the probability of death within 12 months, adjusted odds ratio (OR), 2.15; 95% confidence interval (CI) 1.68–2.76, p < 0.001. For 69.5% of survivors, the FSS one year after ICU admission was unchanged or higher than their premorbid FSS and 84.2% of patients living at home before ICU admission still lived at home.ConclusionsPoor PFS doubled the odds of death within one year. For most survivors, functional status was comparable to the premorbid status.
Highlights
Poor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older
Poor PFS increased the probability of death within 12 months, adjusted odds ratio (OR), 2.15; 95% confidence interval (CI) 1.68–2.76, p < 0.001
We found that a poor premorbid functional status (PFS) [needing assistance for activities of daily living (ADL) or being unable to climb stairs] is associated with a twofold increase in the odds of death within 12 months after ICU admission in patients aged 80 years or older [17]
Summary
Poor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older. Pietiläinen et al BMC Geriatrics (2022) 22:38 These patients may have an impaired capacity to recover from a critical illness [3,4,5,6], reflected in the ICU prognostic scoring systems, where all patients aged 80 years or older receive a maximal number of points from age [7, 8]. Focusing on factors reflecting the physiological potential for recovery could be helpful in decision-making Examples of such factors are functional capacity and frailty, which have been documented in several ICU studies and found to be useful in predicting outcomes in very old intensive care patients [12,13,14,15,16]
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