Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study

The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (...

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Published in:Journal of critical care 2020-12, Vol.60, p.58-63
Main Authors: Bruno, Raphael Romano, Wernly, Bernhard, Beil, Michael, Muessig, Johanna M., Rahmel, Tim, Graf, Tobias, Meybohm, Patrick, Schaller, Stefan J., Allgäuer, Sebastian, Franz, Marcus, Westphal, Julian Georg, Barth, Eberhard, Ebelt, Henning, Fuest, Kristina, Horacek, Michael, Schuster, Michael, Dubler, Simon, Schering, Stefan, Wolff, Georg, Steiner, Stephan, Rabe, Christian, Dieck, Thorben, Lauten, Alexander, Sacher, Anne Lena, Brenner, Thorsten, Bloos, Frank, Jánosi, Rolf A., Simon, Philipp, Utzolino, Stefan, Kelm, Malte, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Jung, Christian
Format: Article
Language:English
Subjects:
Aged, 80 and over
Clinical decision making
Critical Care - methods
Decision making
Disease management
Elderly
Female
Frailty
Frailty - epidemiology
Frailty - mortality
Frailty - therapy
Germany - epidemiology
Hospital Mortality
Hospitalization
Humans
Intensive care
Intensive care medicine
Intensive care outcome
Intensive Care Units
Length of Stay
Logistic Models
Male
Mortality
Older
Older people
Oldest old people
Organ Dysfunction Scores
Prospective Studies
Risk factors
Treatment Outcome
VIP
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Summary:The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82–88] vs. 83 [IQR 81–86] years p 
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2020.07.024