Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

Bernhard Wernly; Raphael Romano Bruno; Fernando Frutos-Vivar; Oscar Peñuelas; Richard Rezar; Konstantinos Raymondos; Alfonso Muriel; Bin Du; Arnaud W Thille; Fernando Ríos; Marco González; Lorenzo Del-Sorbo; Maria Del Carmen Marín; Bruno Valle Pinheiro; Marco Antonio Soares; Nicolas Nin; Salvatore M Maggiore; Andrew Bersten; Malte Kelm; Pravin Amin; Nahit Cakar; Gee Young Suh; Fekri Abroug; Manuel Jibaja; Dimitros Matamis; Amine Ali Zeggwagh; Yuda Sutherasan; Bertrand Guidet; Dylan W De Lange; Michael Beil; Sigal Svri; Vernon van Heerden; Hans Flaatten; Antonio Anzueto; Venet Osmani; Andrés Esteban; Christian Jung

doi:10.4187/respcare.08547

Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

Bernhard Wernly, Raphael Romano Bruno, Fernando Frutos-Vivar, Oscar Peñuelas, Richard Rezar, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin AminNahit Cakar, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Bertrand Guidet, Dylan W De Lange, Michael Beil, Sigal Svri, Vernon van Heerden, Hans Flaatten, Antonio Anzueto, Venet Osmani, Andrés Esteban, Christian Jung

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).

Original language	English
Pages (from-to)	814-821
Number of pages	8
Journal	Respiratory Care
Volume	66
Issue number	5
Early online date	2 Mar 2021
DOIs	https://doi.org/10.4187/respcare.08547
Publication status	Published - 1 May 2021

Keywords

ICU
mechanical ventilation
Elderly subjects
Critically ill
Risk stratification
Risk scores

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Wernly, B., Bruno, R. R., Frutos-Vivar, F., Peñuelas, O., Rezar, R., Raymondos, K., Muriel, A., Du, B., Thille, A. W., Ríos, F., González, M., Del-Sorbo, L., Marín, M. D. C., Pinheiro, B. V., Soares, M. A., Nin, N., Maggiore, S. M., Bersten, A., Kelm, M., ... Jung, C. (2021). Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients. Respiratory Care, 66(5), 814-821. https://doi.org/10.4187/respcare.08547

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title = "Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients",

abstract = "BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).",

keywords = "ICU, mechanical ventilation, Elderly subjects, Critically ill, Risk stratification, Risk scores",

author = "Bernhard Wernly and Bruno, {Raphael Romano} and Fernando Frutos-Vivar and Oscar Pe{\~n}uelas and Richard Rezar and Konstantinos Raymondos and Alfonso Muriel and Bin Du and Thille, {Arnaud W} and Fernando R{\'i}os and Marco Gonz{\'a}lez and Lorenzo Del-Sorbo and Mar{\'i}n, {Maria Del Carmen} and Pinheiro, {Bruno Valle} and Soares, {Marco Antonio} and Nicolas Nin and Maggiore, {Salvatore M} and Andrew Bersten and Malte Kelm and Pravin Amin and Nahit Cakar and {Young Suh}, Gee and Fekri Abroug and Manuel Jibaja and Dimitros Matamis and Zeggwagh, {Amine Ali} and Yuda Sutherasan and Bertrand Guidet and {De Lange}, {Dylan W} and Michael Beil and Sigal Svri and {van Heerden}, Vernon and Hans Flaatten and Antonio Anzueto and Venet Osmani and Andr{\'e}s Esteban and Christian Jung",

note = "Publisher Copyright: {\textcopyright} 2021 Daedalus Enterprises.",

year = "2021",

month = may,

day = "1",

doi = "10.4187/respcare.08547",

language = "English",

volume = "66",

pages = "814--821",

journal = "Respiratory Care",

issn = "0020-1324",

publisher = "American Association for Respiratory Care",

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Wernly, B, Bruno, RR, Frutos-Vivar, F, Peñuelas, O, Rezar, R, Raymondos, K, Muriel, A, Du, B, Thille, AW, Ríos, F, González, M, Del-Sorbo, L, Marín, MDC, Pinheiro, BV, Soares, MA, Nin, N, Maggiore, SM, Bersten, A, Kelm, M, Amin, P, Cakar, N, Young Suh, G, Abroug, F, Jibaja, M, Matamis, D, Zeggwagh, AA, Sutherasan, Y, Guidet, B, De Lange, DW, Beil, M, Svri, S, van Heerden, V, Flaatten, H, Anzueto, A, Osmani, V, Esteban, A & Jung, C 2021, 'Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients', Respiratory Care, vol. 66, no. 5, pp. 814-821. https://doi.org/10.4187/respcare.08547

TY - JOUR

T1 - Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

AU - Wernly, Bernhard

AU - Bruno, Raphael Romano

AU - Frutos-Vivar, Fernando

AU - Peñuelas, Oscar

AU - Rezar, Richard

AU - Raymondos, Konstantinos

AU - Muriel, Alfonso

AU - Du, Bin

AU - Thille, Arnaud W

AU - Ríos, Fernando

AU - González, Marco

AU - Del-Sorbo, Lorenzo

AU - Marín, Maria Del Carmen

AU - Pinheiro, Bruno Valle

AU - Soares, Marco Antonio

AU - Nin, Nicolas

AU - Maggiore, Salvatore M

AU - Bersten, Andrew

AU - Kelm, Malte

AU - Amin, Pravin

AU - Cakar, Nahit

AU - Young Suh, Gee

AU - Abroug, Fekri

AU - Jibaja, Manuel

AU - Matamis, Dimitros

AU - Zeggwagh, Amine Ali

AU - Sutherasan, Yuda

AU - Guidet, Bertrand

AU - De Lange, Dylan W

AU - Beil, Michael

AU - Svri, Sigal

AU - van Heerden, Vernon

AU - Flaatten, Hans

AU - Anzueto, Antonio

AU - Osmani, Venet

AU - Esteban, Andrés

AU - Jung, Christian

PY - 2021/5/1

Y1 - 2021/5/1

N2 - BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).

AB - BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).

KW - ICU

KW - mechanical ventilation

KW - Elderly subjects

KW - Critically ill

KW - Risk stratification

KW - Risk scores

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U2 - 10.4187/respcare.08547

DO - 10.4187/respcare.08547

M3 - Article

C2 - 33653910

SN - 0020-1324

VL - 66

SP - 814

EP - 821

JO - Respiratory Care

JF - Respiratory Care

IS - 5

ER -

Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

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