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Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.
Antoine Guillon
Centre Hospitalier Regional Universitaire de Tours
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4884-8620
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.
Methods We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.
Results 1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.
Conclusions We observed a substantially increased rate of death in the years following ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
Funding: None
Keywords
respiratory infection, intensive care unit, elderly, epidemiology
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CURRENT STATUS: Published
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On 29 Jun, 2020
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On 16 Jun, 2020
Editorial decision: Accept
On 16 Jun, 2020
Submission checks complete
On 15 Jun, 2020
Editor invited
On 15 Jun, 2020
Community comments: 2
Editorial decision: Minor revision
On 01 Jun, 2020
Reviewer #4 agreed
On 31 May, 2020
Review #4 received
Received 31 May, 2020
Review #3 received
Received 12 May, 2020
Reviewer #3 agreed
On 11 May, 2020
Reviewers invited
Invitations sent on 09 May, 2020
Reviewer #1 agreed
On 09 May, 2020
Reviewer #2 agreed
On 09 May, 2020
Review #1 received
Received 09 May, 2020
Review #2 received
Received 09 May, 2020
Editor assigned
On 30 Apr, 2020
Submission checks complete
On 29 Apr, 2020
Editor invited
On 29 Apr, 2020
No comments provided
Editorial decision: Major revision
On 25 Mar, 2020
Review #4 received
Received 24 Mar, 2020
Reviewer #4 agreed
On 13 Mar, 2020
Review #3 received
Received 03 Mar, 2020
Review #2 received
Received 20 Feb, 2020
Review #1 received
Received 11 Feb, 2020
Reviewer #3 agreed
On 10 Feb, 2020
Reviewer #2 agreed
On 09 Feb, 2020
Reviewers invited
Invitations sent on 08 Feb, 2020
Reviewer #1 agreed
On 08 Feb, 2020
Editor assigned
On 05 Feb, 2020
Submission checks complete
On 04 Feb, 2020
Editor invited
On 04 Feb, 2020
First submitted
On 31 Jan, 2020
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity-score matched cohort study.
Antoine Guillon
Centre Hospitalier Regional Universitaire de Tours
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4884-8620
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 17 Jun, 2020
Published
On 29 Jun, 2020
No community comments so far
Editor assigned
On 16 Jun, 2020
Editorial decision: Accept
On 16 Jun, 2020
Submission checks complete
On 15 Jun, 2020
Editor invited
On 15 Jun, 2020
Community comments: 2
Editorial decision: Minor revision
On 01 Jun, 2020
Reviewer #4 agreed
On 31 May, 2020
Review #4 received
Received 31 May, 2020
Review #3 received
Received 12 May, 2020
Reviewer #3 agreed
On 11 May, 2020
Reviewers invited
Invitations sent on 09 May, 2020
Reviewer #1 agreed
On 09 May, 2020
Reviewer #2 agreed
On 09 May, 2020
Review #1 received
Received 09 May, 2020
Review #2 received
Received 09 May, 2020
Editor assigned
On 30 Apr, 2020
Submission checks complete
On 29 Apr, 2020
Editor invited
On 29 Apr, 2020
No comments provided
Editorial decision: Major revision
On 25 Mar, 2020
Review #4 received
Received 24 Mar, 2020
Reviewer #4 agreed
On 13 Mar, 2020
Review #3 received
Received 03 Mar, 2020
Review #2 received
Received 20 Feb, 2020
Review #1 received
Received 11 Feb, 2020
Reviewer #3 agreed
On 10 Feb, 2020
Reviewer #2 agreed
On 09 Feb, 2020
Reviewers invited
Invitations sent on 08 Feb, 2020
Reviewer #1 agreed
On 08 Feb, 2020
Editor assigned
On 05 Feb, 2020
Submission checks complete
On 04 Feb, 2020
Editor invited
On 04 Feb, 2020
First submitted
On 31 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the two years after discharge in mortality, healthcare utilization and frailty score between elderly survivors of ARI in the ICU and an elderly control population.
Methods We used 2009-2017 data from 39 hospital discharge databases. Patients ≥80 years old discharged alive from ICU-hospitalisation for acute respiratory infection were propensity-score matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilization and frailty scores in the 2-year periods before and after ICU-hospitalisation.
Results 1,220 elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95%CI, 6.1-17.3] higher risk of death at 6 months and 3.6-fold [95%CI, 2.9-4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilization and frailty score in the 2 years after hospital discharge, whereas healthcare utilization and frailty scores among controls were stable before and after hospitalisation.
Conclusions We observed a substantially increased rate of death in the years following ICU-hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
Funding: None
Figure 1
Figure 2
Figure 3