Survival predictors in elderly patients with acute respiratory distress syndrome: a prospective observational cohort study

In the course of the analysis interval, 22,470 admitted grownup sufferers with invasive mechanical air flow have been screened, of whom 1,zero34 (four.6%) met the standards of ARDS (Fig. 1). The sources of sufferers included 9 medical ICUs, 5 post-surgical ICUs, 2 trauma ICUs, 1 burn ICU and emergency division. Eighty-nine sufferers have been excluded, and the remaining 945 sufferers with ARDS have been included for evaluation.Determine 1Flow chart of affected person screening and enrollment for evaluation. ICU intensive care, ARDS acute respiratory misery syndrome.The demographic and scientific traits of the included inhabitants are proven in Desk 1. There have been no considerably completely different in gender, CCI, lung harm rating and mechanical ventilator settings between the youthful (<65 years previous) and older (≥65 years previous) sufferers. The older sufferers had a decrease physique mass index and better APACHE II and SOFA scores than the youthful inhabitants. For the preliminary oxygenation, the older sufferers had a better PaO2/FiO2 ratio (147.9 ± 77.three vs. 134.three ± 70.5 mmHg, p = zero.005) and fewer extreme ARDS (34.1% vs. 40.2%, p = zero.zero41) than the youthful sufferers. The hospital mortality charge was considerably larger in older sufferers than in youthful sufferers (63.9% vs. 50.2%, p < zero.001). For the ARDS sufferers with out co-morbidities (n = 186), the youthful sufferers (n = 108) had decrease hospital mortality charge than older sufferers (n = 78) (34.three% vs. 57.5%, p = zero.001).Desk 1 Demographics and baseline traits of the sufferers with ARDS by age teams.The Desk 2 in contrast the baseline traits of the older sufferers (≥65 years previous) with ARDS between survivors and nonsurvivors. Concerning the danger elements of ARDS in these 463 older sufferers (≥65 years previous), pneumonia was the commonest (n = 354, 76.5%), adopted by sepsis (n = 118, 25.5%), aspiration (n = 37, eight%), and others (n = 18, four.2%). Of the 463 older sufferers with ARDS, the hospital survival charge was 36.1% (167/463). Univariate evaluation confirmed that the CCI, APACHE II rating, SOFA rating, lung harm rating and PIP have been predictors of hospital mortality (Desk three). Multivariate logistic regression evaluation revealed that CCI [odds ratio (OR) 1.111, 95% confidence interval (CI) 1.010–1.222, p = 0.031], SOFA rating (OR 1.127, 95% CI 1.054–1.206, p < zero.001) and PIP (OR 1.zero61, 95% CI 1.zero24–1.099, p = zero.001) have been considerably and independently related to hospital mortality. Regression coefficients of those variables have been used to calculate a pure logarithm of the percentages (logit) of the chance of demise (p), as follows: logit (p) = −2.5 + (zero.11 × CCI) + (zero.12 × SOFA rating) + (zero.06 × PIP).Desk 2 Demographics and baseline traits of the sufferers with ARDS aged ≥65 years previous between survivors and nonsurvivors (n = 463).Desk three Univariate and multivariate logistic regressions analyses of scientific variables related to mortality within the sufferers with ARDS aged ≥65 years previous (n = 463).Of those 463 older sufferers, 194 (41.9%) have been 65–74 years previous, 189 (40.eight%) have been 75–84 years previous, and 80 (17.three%) have been ≥85 years previous. Demographic and scientific traits of those three age teams are in contrast in Desk four. There was no vital distinction in gender, CCI, APACHE II, SOFA, lung harm rating, mechanical ventilator settings and severity of ARDS amongst these three teams. For these older ARDS sufferers (≥65 years previous), the ICU and hospital mortality charges weren’t considerably completely different in delicate (n = 119), average (n = 186) and extreme (n = 158) ARDS (43.7% vs. 47.eight% vs 57%, respectively, p = zero.07; and 63.9% vs. 61.three% vs. 67.1%, respectively, p = zero.536).Desk four Demographics and baseline traits of the sufferers with ARDS aged ≥65 years previous (n = 463).The ≥85 years previous group had a considerably decrease physique mass index than the 65–74 years group (22.three ± three.four vs. 23.eight ± four.1, p = zero.zero25). There was no vital distinction in ICU or hospital mortality charges among the many three teams (45% vs. 48.7% vs. 53.1%, respectively, p = zero.433; and 60% vs. 65.6% vs. 63.9%, respectively, p = zero.682), and no considerably completely different in days of mechanical air flow among the many three teams (19.1 ± 14.6 days, 20.5 ± 15.7 days, and 21.zero ± 15.four days, respectively, p = zero.583). The lengths of keep within the ICU and hospital weren’t considerably completely different among the many three teams (24.zero ± 18.eight days vs. 25.9 ± 21.zero days vs. 26.four ± 20.6 days, respectively, p = zero.565; and 34.7 ± 29.2 days vs. 38.2 ± 31.eight days vs. 35.7 ± 23.four days, respectively, p = zero.459). The main causes of demise of the older sufferers with ARDS have been a number of organ failure (n = 203), adopted by septic shock (n = 46) and refractory hypoxemia (n = 20). Between the three teams, these three main causes of demise weren’t vital distinction (68% vs. 72% vs. 69%, p = zero.81; 17% vs. 15% vs. 16%, p = zero.846; 7% vs. 6% vs. eight%, p = zero.947). For the older sufferers with out co-morbidities (n = 78), the hospital mortality charges weren’t considerably completely different between 65–74 years previous (n = 32), 75–84 years previous (n = 32), and ≥85 years previous (n = 14). (56.2% vs. 56.2 vs. 64.three%, respectively, p = zero.859).Kaplan-Meier survival curves for hospital survival within the completely different age teams are proven in Fig. 2. The youthful sufferers (<65 years previous) had a considerably larger survival charge than the older sufferers (≥65 years previous) (p = zero.0049). Nonetheless, the survival charge was not considerably completely different among the many 65–74, 75–84 and ≥85 years previous teams (p = zero.774).Determine 2Kaplan-Meier survival curves of sufferers with acute respiratory misery syndrome in several age teams. (A) The sufferers <65 years previous had a considerably larger survival charge than these ≥65 years previous (p = zero.0049). (B) The survival charge was not considerably completely different amongst these aged 65–74 years, 75–84 years previous and ≥85 years previous teams (p = zero.774).

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