Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies

• Published in: Journal of critical care 2024-02, Vol.79, p.154439-154439, Article 154439
• Main Authors: Pasieka, Paweł, Surówka, Anna, Fronczek, Jakub, Skwara, Evan, Czuczwar, Mirosław, Borys, Michał, Krawczyk, Paweł, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Żukowski, Maciej, Kotfis, Katarzyna, Cwyl, Katarzyna, Skowronek, Jacek, Solek-Pastuszka, Joanna, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Sierakowska, Katarzyna, Mudyna, Wojciech, Białka, Szymon, Studzińska, Dorota, Bernas, Szymon, Piechota, Mariusz, Machała, Waldemar, Sadowski, Łukasz, Stefaniak, Jan, Owczuk, Radosław, Szymkowiak, Małgorzata, Gawda, Ryszard, Kozera, Natalia, Adamik, Barbara, Goździk, Waldemar, Wieczorek, Agnieszka, Janc, Jarosław, Kluzik, Anna, Trzebicki, Janusz, Zatorski, Paweł, Gola, Wojciech, Hymczak, Hubert, Krzych, Lukasz J., Czajka, Szymon, Kościuczuk, Urszula, Kudliński, Bartosz, Flaatten, Hans, Szczeklik, Wojciech
• Format: Article
• Language: English
• Subjects: Adjustment; End-of-life care; Ethics; Futile therapy; Geriatric population; Intensive care; Length of stay; Limitations of life-sustaining treatment; Medical ethics; Missing data; Mortality; Observational studies; Observational study; Palliative care; Patients; Statistical significance; Variables; VIP study
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2023.154439

Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low. •Poland is marked by low propensity to limit life-sustaining treatment on ICUs compared to other European countries.•The prevalence of limitations of life-sustaining treatment was higher in 2018-2019 cohort compared to 2016-2017 cohort.•Sequential Organ Failure Assessment (SOFA) score was an independent predictor of limiting life-sustaining treatment.•Patients with limitations of life-sustaining treatment had significantly higher mortality and longer ICU length of stay•Poland has no specific legislation regarding end-of-life care, which may impact clinicians' decisions in the ICU.