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Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit
Abstract
Aims. The aims of the present study were to analyse the characteristics of elderly Moroccan patients (aged ≥65 years) admitted to a medical ICU, and to identify factors predicting ICU mortality.
Methods. This was a retrospective study conducted in the medical ICU of a Moroccan university hospital. All elderly patients (≥65 years) with complete records were included, whatever their length of stay. Baseline characteristics, clinical parameters and severity of illness were recorded at admission. Patients were grouped according to their survival status using logistic regression analysis.
Results. During the study period, 1 072 patients were admitted to the ICU, of whom 16.6% (n=179) were older than 65 and had complete records. Fifty-five per cent (n=98) were men. The median age was 70 years (interquartile range 67 - 75 years). The overall ICU mortality was 44.7%, and 64% of deaths occurred in the first 5 days after admission. On univariate analysis, the factors predicting mortality were alcohol misuse (p=0.09), pneumonia (p≤0.001), shock (p=0.001), dehydration (p=0.007), urine output ≤0.5 ml/kg/h (p =0.003), serum urea level >16.6 mmol/l (p=0.01), serum creatinine level >159 µmol/l (p=0.005), and an abnormality on the chest radiograph (p=0.01). The Sequential Organ Failure Assessment (SOFA) score was the most accurate predictor of ICU mortality in this group of elderly patients, with an area under the curve (AUC) of 0.775 (standard deviation (SD) ±0.036). The Acute Physiology and Chronic Health Evaluation II (APACHE II) score also performed adequately (AUC 0.757; SD ±0.037), but the Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) scores were not useful in this group. Two parameters significantly associated with mortality risk were shock (odds ratio (OR) 11.5, 95% confidence interval (CI) 3.7 - 35.7; p<0.001) and pneumonia (OR 3.13, 95% CI 1.5 - 6.2; p<0.001).
Conclusion. Admission of aged patients to the ICU raises important medical, ethical, sociological and economic questions. Our findings suggest that severity of illness, shock and pneumonia on ICU admission were the independent risk factors associated with raised mortality, 64% of which occurred during the 5 days after ICU admission.
Authors' affiliations
Belayachi Jihane, Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
Mina El khayari, Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
Tarek Dendane, Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
Naoufel Madani, Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
Khalid Abidi, Medical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
Redouane Abouqal, Medical Intensive Care Unit, Ibn Sina University Hospital, and Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculté de Médecine et de Pharmacie-Université Mohamed V, Rabat, Morocco
Amine Ali Zeggwagh, Medical Intensive Care Unit, Ibn Sina University Hospital, and Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculté de Médecine et de Pharmacie-Université Mohamed V, Rabat, Morocco
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Article History
Date published: 2012-07-09
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