Zusammenfassung
HINTERGRUND: Patienten, älter als 84 Jahre werden im englischen medizinischen Sprachgebrauch als "oldest old" bezeichnet. Angesichts wachsender ethischer Diskussionen und der zunehmenden Limitierung der finanziellen Mittel im Bereich der intensivmedizinischen Betreuung ist es Ziel der präsentierten Untersuchung einen deskriptiven Überblick über die Prognose und den therapeutischen Aufwand von "oldest old" Patienten auf Intensivstationen im Vergleich zu Patienten jüngeren Alters zu geben. PATIENTEN UND METHODEN: 3069 Patienten, die innerhalb eines Zeitraumes von 7 Jahren an einer Intensivstation zur Aufnahme gelangten, wurden in 4 Altersgruppen unterteilt: jünger als 65 Jahre (48%), 65 bis 74 Jahre (26%), 75 bis 84 Jahre (22%) oder älter (5%; "oldest old"). Zuweisungsdiagnose, Länge des Intensivaufenthaltes, Schweregrad der Erkrankung, gemessen anhand des "simplified acute physiology score (SAPS)-II", Ausmaß des Therapieaufwandes, gemessen anhand des "simplified therapeutic intervention scoring systems (TISS)-28", und Vitalstatus zum Zeitpunkt der Entlassung wurden dokumentiert. ERGEBNISSE: Die Mortalität von Intensivpatienten im Alter von 85 Jahren oder älter war signifikant höher als jene von Patienten jünger als 65 (OR der Mortalität: 1,8, p < 0.001). Insgesamt hatten Patienten, die nicht überlebten höhere SAPS-II-Werte (auch nach Ausschluss der Punkte für Lebensalter), während sich höhere mittlere Tages-TISS-Werte nur bei verstorbenen Patienten jünger als 85 fanden. Es zeigte sich ein negativer Zusammenhang zwischen mittleren Tages-TISS-Werten und dem Lebensalter (r = −0,03; p < 0,001) und signifikant niedere TISS-Tages-Werte bei "oldest old" Patienten im Vergleich zu den Patientengruppen jüngeren Alters (p < 0,001). "Oldest old" Patienten hatten einen signifikant kürzeren mittleren Krankenhausaufenthalt (median: 2; Interquartilenabstand [IQA] 1–3, p < 0,001) als die Patientengruppen jüngeren Alters. SCHLUSSFOLGERUNG: Bei "oldest old" Patienten ist der Faktor Lebensalter ein wichtiger und eigenständiger Prediktor der Mortalität, aber der akute Schweregrad der Erkrankung ist noch stärker mit der Mortalität assoziiert. Zusammenfassend ist das Lebensalter per se ungeeignet als entscheidendes Kriterium für die Zuteilung von ICU-Ressourcen.
Summary
OBJECTIVE: In view of ethical considerations and the limited resources in intensive care medicine, the present investigation aims to give a descriptive overview of the prognosis and therapeutic activity for the oldest age group of elderly patients admitted to an intensive care unit (ICU) in comparison with younger ICU patients. PATIENTS AND METHODS: 3069 patients admitted to the ICU during a seven-year period were categorized into four age groups: under 65 years (48%), 65 to 74 years (26%), 75 to 85 years (22%) and 85 years or older (5%). Type and reason for ICU admission, length of ICU stay, severity of illness as measured by the simplified acute physiology score (SAPS)-II, level of provided care as measured by the simplified therapeutic intervention scoring system (TISS)-28, and vital status at the date of ICU discharge were recorded. RESULTS: The ICU mortality rate of patients aged 85 years or older was significantly higher than in patients under 65 (OR of mortality: 1.8, p < 0.001). Non-survivors had higher SAPS II levels (even when excluding age points) in all age groups, but higher daily average TISS points only in patients under 85. The daily average TISS score was negatively correlated to age (r = −0.03; p < 0.001) and was significantly lower in the oldest group when compared with all the younger groups (p < 0.001). The oldest patients had a significantly shorter length of stay (median: 2; interquartile range [IQR] 1–3, p < 0.001) than the younger patient groups. CONCLUSIONS: Within the very elderly population, age is an important and independent predictor of mortality, but acute severity of illness is even more strongly associated with mortality. Consequently, age alone may be an inappropriate criterion for allocation of ICU resources.
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Brunner-Ziegler, S., Heinze, G., Ryffel, M. et al. "Oldest old" patients in intensive care: prognosis and therapeutic activity. Wien Klin Wochenschr 119, 14–19 (2007). https://doi.org/10.1007/s00508-007-0771-x
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DOI: https://doi.org/10.1007/s00508-007-0771-x