Abstract
Abstract Objective: Conduct a survival analysis of elderly patients hospitalized in an intensive care unit (ICU), identifying the predictors of mortality among this age group. Methods: A retrospective cohort study was performed with data from the medical records of 457 elderly patients hospitalized in an ICU located in the city of Natal in Brazil. Survival functions were estimated using the Kaplan-Meier estimator, and the Log-rank test was used for comparisons. In addition, a multiple Cox proportional hazards model was constructed to identify the independent effects of the predictors of survival. Results: It was found that the survival of elderly ICU patients declined due to factors such as increased hospitalization time, advancing years, unmarried (including common-law-marriage) status, the presence of shock, pneumonia, septicaemia, fractures, a reduced state of consciousness, hospitalization for clinical reasons, being bedridden prior to hospitalization, fever, bradycardia, hypotension, cardiac arrest and the need for mechanical ventilation. The multiple Cox proportional hazards model revealed that variables such as shock, longevity, bradycardia, fractures, fever, hospitalization in the public healthcare system and admission for clinical reasons remained significant as predictors of reduced survival in intensive care units. Conclusions: The survival rates of elderly persons in an ICU in the city of Natal in Brazil were affected by demographic and clinical predictors, and those related to the type of hospitalization and the health care network. This shows that any initiative aimed at increasing the survival of elderly ICU patients must look at individual and social issues and factors related to the health care network.
Highlights
Persons hospitalized in the intensive care unit (ICU) for longer periods, who were older, unmarried, hospitalized in the SUS, diagnosed with shock, pneumonia, sepsis, fractures, had a reduced level of consciousness, were affected by clinical disorders, bedridden before hospitalization, exhibited fever, bradycardia, hypotension, cardiorespiratory arrest and required mechanical ventilation had lower survival rates during the study period
When these findings were subjected to the Cox proportional multiple model, it was observed that only the variables shock, older elderly persons, bradycardia, fractures, fever, hospitalization via the public network and admission due to clinical reasons remained as prognostic factors for lower survival rates among elderly persons admitted to the ICU
Comorbidities and previously diagnosed chronic diseases unrelated to the reason for the current hospitalization were not associated with the survival of the elderly persons at any of the analysis levels
Summary
MEtHODS of days recorded on the HA), starting with the hospitalization of the elderly in the ICU and with. The data were collected from 155 ICU beds, of which 101 were from the SUS and 54 were from private institutions This total represented 62% of days[11,12,13]. It should be stated that the from the health institution[11] This was taken into three-month period for data collection established account as both the infection and sepsis variables in the pilot study did not result in seasonal bias, were found to be important during preliminary as the prevalence of the hospitalization of elderly analyzes of the database. A lower survival rate was researchers to patient record data was requested from observed among elderly persons in the age group of the institutions, with the anonymity of the names of 80 years or older, who were unmarried
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