Risk factors for poor outcome in older patients admitted in a surgical intensive care unit.

Abstract

The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6-months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta=6-months ADL - ICU admission ADL) was between 0 and -0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Fifty-six patients-32 (57%) male-aged 79 [77; 83]y were included. ICU mortality was 19%; 6-month mortality was 22%. Median ADL delta was -0.5 [-0.5-0] points. A low ADL score (P=.0438) and a low albumin level (P=.0213) at admission were the two independent factors associated with an unfavourable outcome. Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis.