Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

BACKGROUND: The number of intensive care patients aged=80years (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 cons...

Descripción completa

Detalles Bibliográficos
Autores: Ibarz, Mercedes, Boumendil, Ariane, Haas, Lenneke E M, Irazabal, Marian, Flaatten, Hans, de Lange, Dylan W, Morandi, Alessandro, Andersen, Finn H, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjolner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Ohman, Christina Agwald, Bollen Pinto, Bernardo, Soliman, Ivo W, Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Artigas, Antonio, VIP1 study
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p4432
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/4432
Access Level:acceso abierto
Palabra clave:Sepsis
Very old
Intensive care
Severity of illness
Outcome
Survival
Mortality
id ES_7c378e12e673aa835c0187727eb4c8d8
oai_identifier_str oai:incliva.fundanetsuite.com:p4432
network_acronym_str ES
network_name_str España
repository_id_str
spelling Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort studyIbarz, MercedesBoumendil, ArianeHaas, Lenneke E MIrazabal, MarianFlaatten, Hansde Lange, Dylan WMorandi, AlessandroAndersen, Finn HBertolini, GuidoCecconi, MaurizioChristensen, SteffenFaraldi, LoredanaFjolner, JesperJung, ChristianMarsh, BrianMoreno, RuiOeyen, SandraOhman, Christina AgwaldBollen Pinto, BernardoSoliman, Ivo WSzczeklik, WojciechValentin, AndreasWatson, XimenaZaferidis, TilemachosGuidet, BertrandArtigas, AntonioVIP1 studyVIP1 studySepsisVery oldIntensive careSeverity of illnessOutcomeSurvivalMortalityBACKGROUND: The number of intensive care patients aged=80years (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 30days 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.SPRINGER2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/4432Annals of Intensive CareISSN: 21105820reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p44322026-06-07T16:35:31Z
dc.title.none.fl_str_mv Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
title Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
spellingShingle 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, Mercedes
Sepsis
Very old
Intensive care
Severity of illness
Outcome
Survival
Mortality
title_short Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
title_full Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
title_fullStr Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
title_full_unstemmed Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
title_sort Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study
dc.creator.none.fl_str_mv Ibarz, Mercedes
Boumendil, Ariane
Haas, Lenneke E M
Irazabal, Marian
Flaatten, Hans
de Lange, Dylan W
Morandi, Alessandro
Andersen, Finn H
Bertolini, Guido
Cecconi, Maurizio
Christensen, Steffen
Faraldi, Loredana
Fjolner, Jesper
Jung, Christian
Marsh, Brian
Moreno, Rui
Oeyen, Sandra
Ohman, Christina Agwald
Bollen Pinto, Bernardo
Soliman, Ivo W
Szczeklik, Wojciech
Valentin, Andreas
Watson, Ximena
Zaferidis, Tilemachos
Guidet, Bertrand
Artigas, Antonio
VIP1 study
VIP1 study
author Ibarz, Mercedes
author_facet Ibarz, Mercedes
Boumendil, Ariane
Haas, Lenneke E M
Irazabal, Marian
Flaatten, Hans
de Lange, Dylan W
Morandi, Alessandro
Andersen, Finn H
Bertolini, Guido
Cecconi, Maurizio
Christensen, Steffen
Faraldi, Loredana
Fjolner, Jesper
Jung, Christian
Marsh, Brian
Moreno, Rui
Oeyen, Sandra
Ohman, Christina Agwald
Bollen Pinto, Bernardo
Soliman, Ivo W
Szczeklik, Wojciech
Valentin, Andreas
Watson, Ximena
Zaferidis, Tilemachos
Guidet, Bertrand
Artigas, Antonio
VIP1 study
author_role author
author2 Boumendil, Ariane
Haas, Lenneke E M
Irazabal, Marian
Flaatten, Hans
de Lange, Dylan W
Morandi, Alessandro
Andersen, Finn H
Bertolini, Guido
Cecconi, Maurizio
Christensen, Steffen
Faraldi, Loredana
Fjolner, Jesper
Jung, Christian
Marsh, Brian
Moreno, Rui
Oeyen, Sandra
Ohman, Christina Agwald
Bollen Pinto, Bernardo
Soliman, Ivo W
Szczeklik, Wojciech
Valentin, Andreas
Watson, Ximena
Zaferidis, Tilemachos
Guidet, Bertrand
Artigas, Antonio
VIP1 study
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Sepsis
Very old
Intensive care
Severity of illness
Outcome
Survival
Mortality
topic Sepsis
Very old
Intensive care
Severity of illness
Outcome
Survival
Mortality
description BACKGROUND: The number of intensive care patients aged=80years (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 30days 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.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/4432
url https://incliva.portalinvestigacion.com/publicaciones/4432
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER
publisher.none.fl_str_mv SPRINGER
dc.source.none.fl_str_mv Annals of Intensive Care
ISSN: 21105820
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869411573531934720
score 15.811543

Similares en LA Referencia