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Minerva Anestesiologica 2017 December;83(12):1283-93

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, GiViTI Group 

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



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 five years (2011-2015) to 163 Italian general ICUs.
METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. 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 four out of five 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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