Outcome of elderly patients who receive intensive care at a regional hospital in Hong Kong

Abstract

Objective: To evaluate the clinical outcome (180- day mortality) of very elderly critically ill patients (age ≥80 years) and compare with those aged 60 to 79 years. Design: Historical cohort study. Setting: Regional hospital, Hong Kong. Patients: Patients aged ≥60 years admitted between 1 January 2009 and 31 December 2013 to the Intensive Care Unit of the hospital. Results: Over 5 years, 4226 patients aged ≥60 years were admitted (55.5% total intensive care unit admissions), of whom 32.8% were aged ≥80 years. The proportion of patients aged ≥80 years increased over 5 years. As expected, those aged ≥80 years carried more significant co-morbidities and a higher disease severity compared with those aged 60 to 79 years. They required more mechanical ventilatory support, were less likely to receive renal replacement therapy, and had a higher intensive care unit/hospital/180- day mortality compared with those aged 60 to 79 years. Nonetheless, 71.8% were discharged home and 62.2% survived >180 days following intensive care unit admission. Cox regression analysis revealed that Acute Physiology and Chronic Health Evaluation IVminus- Age score, emergency admission, intensive care unit admission due to cardiovascular problem, neurosurgical cases, presence of significant co-morbidities (diabetes mellitus, metastatic carcinoma, leukaemia, or myeloma), and requirement for mechanical ventilation independently predicted 180-day mortality. Conclusions: The proportion of critically ill patients aged ≥80 years increased over a 5-year period. Despite having more significant co-morbidities, greater disease severity, and higher intensive care unit/hospital/180-day mortality rate compared with those aged 60 to 79 years, 71.8% of those ≥80 years could be discharged home and 62.2% survived >180 days following intensive care unit admission. Disease severity, presence of co-morbidities, requirement for mechanical ventilation, emergency cases, and admission diagnosis independently predicted 180-day mortality.