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Bicocca Open Archive
Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
Ibarz, M., Boumendil, A., Haas, L., Irazabal, M., Flaatten, H., de Lange, D., et al. (2020). Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study. ANNALS OF INTENSIVE CARE, 10(1) [10.1186/s13613-020-00672-w].
Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
Ibarz M.;Boumendil A.;Haas L. E. M.;Irazabal M.;Flaatten H.;de Lange D. W.;Morandi A.;Andersen F. H.;Bertolini G.;Cecconi M.;Christensen S.;Faraldi L.;Fjolner J.;Jung C.;Marsh B.;Moreno R.;Oeyen S.;Ohman C. A.;Bollen Pinto B.;Soliman I. W.;Szczeklik W.;Valentin A.;Watson X.;Zaferidis T.;Guidet B.;Artigas A.;Schmutz R.;Wimmer F.;Eller P.;Joannidis M.;De Buysscher P.;De Neve N.;Oeyen S.;Swinnen W.;Bollen Pinto B.;Abraham P.;Hergafi L.;Schefold J. C.;Biskup E.;Piza P.;Taliadoros I.;Fjolner J.;Dey N.;Solling C.;Rasmussen B. S.;Christensen S.;Forceville X.;Besch G.;Mentec H.;Michel P.;Mateu P.;Michel P.;Vettoretti L.;Bourenne J.;Marin N.;Guillot M.;Aissaoui N.;Goulenok C.;Thieulot-Rolin N.;Messika J.;Lamhaut L.;Guidet B.;Charron C.;Lauten A.;Sacher A. L.;Brenner T.;Franz M.;Bloos F.;Ebelt H.;Schaller S. J.;Fuest K.;Rabe C.;Dieck T.;Steiner S.;Graf T.;Nia A. M.;Jung C.;Janosi R. A.;Meybohm P.;Simon P.;Utzolino S.;Rahmel T.;Barth E.;Schuster M.;Aidoni Z.;Aloizos S.;Tasioudis P.;Lampiri K.;Zisopoulou V.;Ravani I.;Pagaki E.;Antoniou A.;Katsoulas T. A.;Kounougeri A.;Marinakis G.;Tsimpoukas F.;Spyropoulou A.;Zygoulis P.;Kyparissi A.;Gupta M.;Gurjar M.;Maji I. M.;Hayes I.;Kelly Y.;Westbrook A.;Fitzpatrick G.;Maheshwari D.;Motherway C.;Negri G.;Spadaro S.;Nattino G.;Pedeferri M.;Boscolo A.;Rossi S.;Calicchio G.;Cubattoli L.;Di Lascio G.;Barbagallo M.;Berruto F.;Codazzi D.;Bottazzi A.;Fumagalli P.;Negro G.;Lupi G.;Savelli F.;Vulcano G. A.;Fumagalli R.;Marudi A.;Lefons U.;Lembo R.;Babini M.;Paggioro A.;Parrini V.;Zaccaria M.;Clementi S.;Gigliuto C.;Facondini F.;Pastorini S.;Munaron S.;Calamai I.;Bocchi A.;Adorni A.;Bocci M. G.;Cortegiani A.;Casalicchio T.;Melia S.;Graziani E.;Barattini M.;Brizio E.;Rossi M.;Hahn M.;Flattens H.;Kemmerer N.;Streiter H. F.;Dybwik K.;Legernaes T.;Klepstad P.;Olaussen E. B.;Olsen K. I.;Brresen O. M.;Bjorsvik G.;Maini S.;Fehrle L.;Andersen F. H.;Krawczyk P.;Zietkiewicz M.;Nowak L. R.;Kotfis K.;Cwyl K.;Gajdosz R.;Biernawska J.;Bohatyrewicz R.;Gawda R.;Grudzien P.;Nasilowski P.;Popek N.;Cyrankiewicz W.;Wawrzyniak K.;Wnuk M.;Maciejewski D.;Studzinska D.;Zukowski M.;Bernas S.;Piechota M.;Nowak-Kozka I.;Fronczek J.;Serwa M.;Szczeklik W.;Stefaniak J.;Wujtewicz M.;Szymkowiak M.;Adamik B.;Polok K.;Wludarczyk A.;Gorka J.;Kozera N.;Gozdzik W.;Catorze N.;Branco M. C.;Barros I.;Barros N.;Krystopchuk A.;Honrado T.;Sousa C.;Munoz F.;Rebelo M.;Gomes R.;Nunes J.;Dias C.;Fernandes A. M.;Petrisor C.;Constantin B.;Belskiy V.;Boskholov B.;Rodriguez E.;Rebollo S.;Aguilar G.;Masdeu G.;Jaimes M. I.;Mira A. P.;Bodi M. A.;Barea Mendoza J. A.;Lopez-Cuenca S.;Guzman M. H.;Rico-Feijoo J.;Alvarez J. T.;Kawati R.;Sivik J.;Nauska J.;Ibarz M.;Parenmark F.;Lyren J.;Rockstrohm K.;Ryden S.;Spangfors M.;Strinnholm M.;Walther S.;De Geer L.;Nordlund P.;Palsson S.;Zetterquist H.;Nilsson A.;Thiringer K.;Jungner M.;Bark B.;Nordling B.;Skold H.;Brorsson C.;Persson S.;Bergstrom A.;Berkius J.;Holmstrom J.;van Dijk I.;Ramnarain D.;Jansen T.;Nooteboom F.;van der Voort P. H. J.;Dieperink W.;de Waard M. C.;de Smet A. G. E.;Bormans L.;Dormans T.;Dempsey G.;Mathew S. J.;Raj A. S.;Grecu I.;Cupitt J.;Lawton T.;Clark R.;Popescu M.;Spittle N.;Faulkner M.;Cowton A.;Elloway E.;Williams P.;Reay M.;Chukkambotla S.;Kumar R.;Al-Subaie N.;Kent L.;Tamm T.;Kajtor I.;Burns K.;Pugh R.;Ostermann M.;Kam E.;Bowyer H.;Smith N.;Templeton M.;Henning J.;Goffin K.;Kapoor R.;Laha S.;Chilton P.;Khaliq W.;Crayford A.;Coetzee S.;Tait M.;Stoker W.;Gimenez M.;Pope A.;Camsooksai J.;Pogson D.;Quigley K.;Ritzema J.;Hormis A.;Boulanger C.;Balasubramaniam M.;Vamplew L.;Burt K.;Martin D.;Grecu I.;Craig J.;Prowle J.;Doyle N.;Shelton J.;Scott C.;Donnison P.;Shelton S.;Frey C.;Ryan C.;Spray D.;Ryan C.;Barnes V.;Barnes K.;Ridgway S.;Saha R.;Kent L.;Clark T.;Wood J.;Bolger C.;Bassford C.;Cowton A.;Lewandowski J.;Zhao X.;Humphreys S.;Dowling S.;Richardson N.;Burtenshaw A.;Stevenson C.;Wilcock D.;Nalapko Y.
2020
Abstract
Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
Ibarz, M., Boumendil, A., Haas, L., Irazabal, M., Flaatten, H., de Lange, D., et al. (2020). Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study. ANNALS OF INTENSIVE CARE, 10(1) [10.1186/s13613-020-00672-w].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/304291
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 598/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
