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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Jun 14

DOI: 10.23736/S0375-9393.17.11919-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

Daniele POOLE 1 , Stefano FINAZZI 2, Giovanni NATTINO 2, Danilo RADRIZZANI 3, Giuseppe GRISTINA 4, Paolo MALACARNE 5, Sergio LIVIGNI 6, Guido BERTOLINI 2, on behalf of GiViTI 

1 Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy; 2 GiViTI Coordinating Center, IRCCS, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Ranica, Bergamo, Italy; 3 Anesthesia and Intensive Care Unit, Ospedale Civile, Legnano, Milan, Italy; 4 Italian Society of Anesthesia and Intensive Care (SIAARTI) Ethical Committee, Rome, Italy; 5 Anesthesia and Intensive Care Operative Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 6 Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, B-DEA, Turin, Italy


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BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in 5 years (2011-2015) to 163 Italian general ICUs.
METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analysed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours.
RESULTS: 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in 4 of 5 models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death.
CONCLUSIONS: Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death.


KEY WORDS: Aged - Critical care - Prognosis

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Cite this article as

Poole D, Finazzi S, Nattino G, Radrizzani D, Gristina G, Malacarne P, et al; GiViTI. The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs. Minerva Anestesiol 2017 Jun 14. DOI: 10.23736/S0375-9393.17.11919-X

GiViTI

Cristina SORGATO, Abano Terme, Padua, Italy; Roberto MANNONI, Acqui Terme, Alessandria, Italy; Vanessa AGNELLI, Acqui Terme, Alessandria, Italy; Cristina CHIANI, Adria, Rovigo, Italy; Giuseppina LANZA, Alba, Cuneo, Italy; Elisabetta VENTURINI, Alessandria, Italy; Massimo GIANNI, Aosta, Italy; Maria C. OLIVIERI, Arezzo, Italy; Barbara GUERRIERO, Ariano Irpino, Avellino, Italy; Ernesto DELLA MORA, Arzignano, Vicenza, Italy; Maurizio PALMER, Aversa, Caserta, Italy; Angelo BLASETTI, Avezzano, Aquila, Italy; Rosaria COLETTA, Avezzano, Aquila, Italy; Francesca COVANI FRIGIERI, Bagno a Ripoli, Florence, Italy; Maria D. GUARDUCCI, Bagno a Ripoli, Florence, Italy; Adalgisa CARACCIOLO, Bari, Italy; Giuseppe LAIN, Bassano del Grappa, Vicenza, Italy; Daniele POOLE, Belluno, Italy; Moira BERNARD, Belluno, Italy; Elvio DE BLASIO, Benevento, Italy; Vittorio ZANNI, Bentivoglio, Bologna, Italy; Gianmariano MARCHESI, Bergamo, Italy; Susana M. MADEIRA, Bibbiena, Arezzo, Italy; Ermanno SPAGARINO, Biella, Italy; Antonella POTALIVO, Bologna, Italy; Francesca MENGOLI, Bologna; Vieri PARRINI, Borgo San Lorenzo, Florence, Italy; Ugo SAGLIASCHI, Borgomanero, Novara, Italy; Andrea PRANDINI, Brescia, Italy; Antonio ROSANO, Brescia, Italy; Giuseppe NATALINI, Brescia, Italy; Giuseppe PICCIONI, Brescia, Italy; Marina SCHIAVUZZI, Brescia, Italy; Nicola BRONZINI, Brescia, Italy; Simone PIVA, Brescia, Italy; Alessandra BESOZZI, Busto Arsizio, Varese, Italy; Alessandra NAPOLEONE, Cagliari, Italy; Luca PATRIGNANI, Cagliari, Italy; Marina PISU, Cagliari, Italy; Stefano MANCOSU, Cagliari, Italy; Marco CHIARELLO, Camerino, Macerata, Italy; Simonetta PASTORINI, Camposampiero, Padua, Italy; Giovanni BASSI, Carrara, Massa-Carrara, Italy; Giancarlo NEGRO, Casarano, Lecce, Italy; Ivana ORSINI, Caserta, Italy; Demostene MARIFOGLOU, Castel San Giovanni, Piacenza, Italy; Vincenzo POTA, Castel Volturno, Caserta, Italy; Maurizio PEGORARO, Castelfranco Veneto, Treviso, Italy; Maria J. SUCRE, Castellammare di Stabia, Napoli, Italy; Pierfrancesco DI MASI, Castellana Grotte, Bari, Italy; Giacomo CASTIGLIONE, Catania, Italy; Gianluigi MORELLO, Catania, Italy; Giuseppe GAROFALO, Catania, Italy; Santo CAROLEO, Catanzaro, Italy; Maria G. VISCONTI, Cernusco sul Naviglio, Milan, Italy; Emiliano GAMBERINI, Cesena, Forlì-Cesena, Italy; Alessandro MASTROIANNI, Chieri, Turin, Italy; Marco M. LICCARDI, Chivasso, Turin, Italy; Daniela ANELATI, Cinisello Balsamo, Milan,, Italy; Stefano MARTINELLI, Città di Castello, Perugia, Italy; Alfeo BONATO, Cittadella, Padua, Italy; Adele ADORNI, Como, Italy; Dario COLOMBO, Como, Italy; Paolo DAL CERO, Conegliano, Treviso, Italy; Luciano CREMA, Cremona, Italy; Nicola PETRUCCI, Desenzano del Garda, Brescia, Italy; Eduardo BECK, Desio, Monza-Brianza, Italy; Sandra ALLEVA, Domodossola, Verbania, Italy; Romano GIUNTINI, Empoli, Florence, Italy; Dolores DA RE, Este, Padua, Italy; Pierpaolo CASALINI, Faenza, Ravenna, Italy; Maria C. FABI, Fano, Pesaro-Urbino, Italy; Elsa GALEOTTI, Feltre, Belluno, Italy; Giampiero BAGALINI, Fermo, Italy; Alessandra BELLONZI, Ferrara, Italy; Roberto ZOPPELLARI, Ferrara, Italy; Sara LAMBORGHINI, Ferrara, Italy; Laura PERA, Florence), Italy; Lorenzo DONI, Florence, Italy; Manuela BONIZZOLI, Florence, Italy; Marco LIBRENTI, Florence, Italy; Massimo BARATTINI, Florence, Italy; Valerio MANGANI, Florence, Italy; Marina TERZITTA, Forlì, Italy; Clementina GUAGLIARDI, Gallarate, Varese, Italy; Cristina BRUZZONE, Genoa, Italy; Enrico ARDITI, Genoa, Italy; Manuela CERANA, Genoa, Italy; Mario TAVOLA, Genoa, Italy; Stefano FALINI, Grosseto, Italy; Maria G. VESPIGNANI, Imola, Bologna, Italy; Giovanni SALVI, Imperia, Italy; Paolo L. RAMELLO, Ivrea, Turin, Italy; Andrea MOLESI, Jesi, Ancona, Italy; Marina CERADELLI, La Spezia, Italy; Roberto BUONANNO, Lacco Ameno, Naples, Italy; Ermino RIGHINI, Lagosanto, Ferrara, Italy; Assunta DI COCCO, Lanciano, Chieti, Italy; Rosalia DI MARTINO, Lanciano, Chieti, Italy; Enrico CINQUE, Lavagna, Genoa, Italy; Monica BONFIGLIO, Lavagna, Genoa, Italy; Rita CICERI, Lecco, Italy; Danilo RADRIZZANI, Legnano, Milan, Italy; Laura COLOMBO, Legnano, Milan, Italy; Massimiliano NARDINI, Lido di Camaiore, Lucca, Italy; Giancarlo ROSSI, Livorno, Italy; Daniela L. BOCCALATTE-ROSA, Lucca, Italy; Maria BABINI, Lugo, Ravenna, Italy; Valeria ZOMPANTI, Macerata, Italy; Giovanni NEGRI, Magenta, Milan, Italy; Benvenuto ANTONINI, Manerbio, Brescia, Italy; Alberto BARATTA, Massa, Italy; Francesco ZUCCARO, Matera, Italy; Maurizio ROSSI, Menaggio, Como, Italy; Matteo PEDEFERRI, Merate, Lecco, Italy; Marzia BELLIN , Mestre, Venice, Italy; Alberto SICIGNANO, Milan, Italy; Angelo PEZZI, Milan, Italy; Carlo LEGGIERI, Milan, Italy; Giancarlo FONTANA, Milan), Italy; Loredana FARALDI, Milan, Italy; Marco G. CIGADA, Milan, Italy; Paolo MAGENTA, Milan, Italy; Riccardo COLOMBO, Milan, Italy; Sergio COLOMBO, Milan, Italy; Silvia GONZI, Milan, Italy; Mario PIZZALI, Mirano, Venice, Italy; Massimo GIRARDIS, Modena, Italy; Paolo PICCININI, Modena, Italy; Paola BIGNONE, Mondovì, Cuneo, Italy; Lamberto PADOVAN, Monselice, Padua, Italy; Andrea BIANCHIN, Montebelluna, Treviso, Italy; Federico C. CARIA, Montebelluna, Treviso, Italy; Roberto RANDELLINI, Montepulciano, Siena, Italy; Valeria ROTICIANI, Montevarchi, Arezzo, Italy; Modestina GRASSI, Monza, Italy; Clara BELLUOMO ANELLO, Naples, Italy; Maria DECRISTOFARO, Naples, Italy; Maurizio POSTIGLIONE, Naples, Italy; Stefano GIACOMELLO, Negrar, Verona, Italy; Carlo OLIVIERI, Novara, Italy; Caterina VACCARI, Novi Ligure, Alessandria, Italy; Marino DAL FERRO, Oderzo, Treviso, Italy; Marianna MESSINA, Olbia, Italy; Nicolangela BELGIORNO, Ome, Brescia, Italy; Lorenzo ODETTO, Orbassano, Turin, Italy; Giovanni S. PASETTI, Orbetello, Grosseto, Italy; Bruno BALICCO, Osio Sotto, Bergamo, Italy; Maria L. PIZZABALLA, Osio Sotto, Bergamo, Italy; Luisa MURARO, Padua, Italy; Amedeo PIGNATARO, Palermo, Italy; Antonina GUADAGNA, Palermo, Italy; Pier G. FABBRI, Palermo, Italy; Romano TETAMO, Palermo, Italy; Andrea BOTTAZZI, Pavia, Italy; Teresa S. MEDIANI, Pavia, Italy; Adonella GORIETTI, Perugia, Italy; Cesare BRESCHI, Pesaro, Italy; Andrea CIANI, Pescia, Pistoia, Italy; Pieraurelio SEGALINI, Piacenza, Italy; Vito CODELUPPI, Pieve di Coriano, Mantova, Italy; Francesco BERRUTO, Pinerolo, Turin, Italy; Mauro PASTORELLI, Pinerolo, Turin, Italy; Claudio COMITE, Pisa, Italy; Erika PELATI, Pisa, Italy; Paolo MALACARNE, Pisa, Italy; Roberta BERTOLINI, Pisa, Italy; Ugo LEFONS, Poggibonsi, Siena, Italy; Dino A. Cleto DI PASQUALE, Pontedera, Pisa, Italy; Giovanni MANNOLINI, Pontremoli, Italy; Francesca VLASSICH, Porto Viro, Rovigo, Italy; Simone BECARELLI, Prato, Italy; Alberto GARELLI, Ravenna, Italy; Pierpaolo SALSI, Reggio Emilia, Italy; Simona ROSSI, Rho, Milan, Italy; Francesca FACONDINI, Rimini, Italy; Daniela ALAMPI, Rome Italy; Emiliano CINGOLANI, Rome, Italy; Fausto M. MOLINO, Rome, Italy; Giuseppe NARDI, Rome, Italy; Maria CASULA, Rome, Italy; Roberto A. DE BLASI, Rome, Italy; Giuseppe A. VULCANO, Rossano, Cosenza, Italy; Maurizio AZZOLINI, Rovereto, Trento, Italy; Mara O. BERNASCONI, Rovigo, Italy; Valentina BELLATO, Rozzano, Milan, Italy; Giuseppe CALICCHIO, Salerno, Italy; Filippo RIGHETTI, San Bonifacio, Verona, Italy; Marialuisa TURATI, San Donà di Piave, Venice, Italy; Marco DEI POLI, San Donato Milanese, Milan, Italy; Germano ZARO, Santorso, Vicenza, Italy; Elisabetta BRIZIO, Savigliano, Cuneo, Italy; Maddalena COALOA, Savigliano, Cuneo, Italy; Gabriele FALZETTI, Senigallia, Ancona, Italy; Filippo MAMPRIN, Seriate, Bergamo, Italy; Chiara M. LIVERANI, Sesto San Giovanni, Milan, Italy; Stefano CLEMENTI, Sesto San Giovanni, Milan, Italy; Paola BONUCCI, Siena, Italy; Vincenzo VARESIO, Sondrio, Italy; Riccardo PANNACCI, Spoleto, Perugia, Italy; Gilberto FIORE, Turin, Italy; Mauro GALLO, Turin, Italy; Mauro TORTA, Turin, Italy; Paola SELVAGGI, Turin, Italy; Paolo P. BERT, Turin, Italy; Vincenzo SEGALA, Turin, Italy; Giorgio PETTAZZI, Tortona, Alessandria, Italy; Marco BENSI, Tortona, Alessandria, Italy; Anna BOCCHI, Trecenta, Rovigo, Italy; Mauro CIMA, Trento, Italy; Mario MORBELLI, Treviglio, Bergamo, Italy; Mario PETA, Treviso, Italy; Rinaldo COLOMBO, Varese, Italy; Roberta DI STELLA, Varese, Italy; Carlo MAGGIOLO, Venice, Italy; Rita LEMBO, Verbania, Italy; Alice PERO, Vercelli, Italy; Silvio MARAFON, Vicenza, Italy; Livio CARNEVALE, Vigevano, Pavia, Italy; Romano VANZINO, Vigevano, Pavia, Italy; Pietro VECCHIARELLI, Viterbo, Italy; Giovanni MARINO, Vizzolo Predabissi, Milan, Italy

Corresponding author e-mail

daniele.poole@alice.it