The effect of age on clinical outcomes in critically ill brain-injured patients
-
Tejerina, Eva E.
- Gonçalves, Gesly
- Gómez-Mediavilla, Karen
- Jaramillo, Carlos
- Jiménez, Jorge
- Frutos-Vivar, Fernando
- Lorente, José Ángel
- Thuissard, Israel J.
- Andreu-Vázquez, Cristina
-
1
Hospital Universitario de Getafe
info
-
2
Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias
info
Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias
Madrid, España
-
3
Universidad Europea de Madrid
info
ISSN: 0300-9009, 2240-2993
Year of publication: 2022
Type: Article
More publications in: Acta Neurologica Belgica
Abstract
Purpose We studied the impact of age on survival and functional recovery in brain-injured patients.Methods We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICUin 8 years. To estimate the optimal cut-of point of the age associated with unfavorable outcomes (mRS 3–6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identifyprognostic factors for unfavorable outcomes.Results We included 619 brain-injured patients. We identifed 60 years as the cut-of point at which the probability of unfavorable outcomes increases. Patients≥60 years had higher severity scores at ICU admission, longer duration of mechanicalventilation, longer ICU and hospital stays, and higher mortality. Factors identifed as associated with unfavorable outcomes(mRS 3–6) were an advanced age (≥60 years) [Odds ratio (OR) 4.59, 95% confdence interval (CI) 2.73–7.74, p<0.001],a low GCS score (≤8 points) [OR 3.72, 95% CI 1.95–7.08, p<0.001], the development of intracranial hypertension [OR5.52, 95% CI 2.70–11.28, p<0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI2.34–6.42, p<0.001].Conclusion Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with olderage (≥60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranialhypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
Funding information
This study was funded by Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES).Funders
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Bibliographic References
- Peñuelas O, Muriel A, Abraira V, Frutos-Vivar F, Mancebo J, Raymondos K et al (2020) Inter-country variability over time in the mortality of mechanically ventilated patients. Intensive Care Med 46:444–453
- Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, Putensen C, Raymondos K et al (2011) Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 39:1482–1492
- Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S et al (2002) Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 53:219–224
- Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R et al (2002) Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma 52:907–911
- Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF et al (2003) Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 99:666–673
- LeBlanc J, de Guise E, Gosselin N, Feyz M (2006) Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury. Brain Inj 20:779–790
- Lenell S, Nyholm L, Lewén A, Enblad P (2019) Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care. Acta Neurochir (Wien) 161:1243–1254
- McIntyre A, Mehta S, Aubut J, Dijkers M, Teasell RW (2013) Mortality among older adults after a traumatic brain injury: a meta-analysis. Brain Inj 27:31–40
- Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D et al (2004) The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma 56:1042–1048
- Reeder KP, Rosenthal M, Lichtenberg P, Wood D (1996) Impact of age on functional outcome following traumatic brain injury. J Head Trauma Rehabil 11:22–31
- Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative STROBE (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808
- Esteban A, Anzueto A, Frutos-Vivar F, Alía I, Ely EW, Brochard L et al (2004) Outcome of older patients receiving mechanical ventilation. Intensive Care Med 30:639–646
- Vollmer D, Torner J, Jane J (1991) Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75(suppl):S37–S49
- Ferrell RB, Kaloyan ST (2002) Traumatic brain injury in older adults. Curr Psychiatry Rep 4:354–362
- Marquez de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR et al (2008) Impact of age on long-term recovery from traumatic brain injury. Arch Phys Med Rehabil 89:896–903
- Canadian Institute for Health Information (2006) Head injuries in Canada: a decade of change. CIHI, Ottawa, ON
- Thompson HJ, McCormick WC, Kagan SH (2006) Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 54:1590–1595
- Thompson HJ, Rivara FP, Jurkovich GJ, Wang J, Nathens AB, MacKenzie EJ (2008) Evaluation of the effect of intensity of care on mortality after traumatic brain injury. Crit Care Med 36:282–290
- Rengel KF, Hayhurst CJ, Pandharipande PP, Hughes CG (2019) Long-term cognitive and functional impairments after critical illness. Anesth Analg 128:772–780
- Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
- Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L et al (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 177:170–177
- Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V et al (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 188:220–230
- Tejerina EE, Pelosi P, Robba C, Peñuelas O, Muriel A, Barrios D, Frutos-Vivar F et al (2021) Evolution over time of ventilator management and outcome of patients with neurologic disease. Crit Care Med 49:1095–1106
- Asehnoune K, Mrozek S, Perrigault PF, Seguin P, Dahyot-Fizelier C, Lasocki S et al (2017) A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project. Intensive Care Med 43:957–970
- Roquilly A, Cinotti R, Jaber S, Vourc’h M, Pengam F, Mahe PJ et al (2013) Implementation of an evidence-based extubation readiness bundle in 499 brain-injured patients. A before-after evaluation of a quality improvement project. Am J Respir Crit Care Med 188:958–966
- Cnossen MC, Polinder S, Andriessen TM, van der Naalt J, Haitsma I, Horn J et al (2017) Causes and consequences of treatment variation in moderate and severe traumatic brain injury: a multicenter study. Crit Care Med 45:660–669
- Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ (2002) Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 30:1870–1876
- Barnato AE, Albert SM, Angus DC, Lave JR, Degenholtz HB (2011) Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 183:1037–1042
- Broessner G, Helbok R, Lackner P, Mitterberger M, Beer R, Engelhardt K et al (2007) Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients. Crit Care Med 35:2025–2030
- Kiphuth IC, Schellinger PD, Köhrmann M, Bardutzky J, Lücking H, Kloska S et al (2010) Predictors for good functional outcome after neurocritical care. Crit Care 14:R136
- Corbanese U, Possamai C, Dal Cero P (2004) Outcome of patients who underwent mechanical ventilation following intracerebral hemorrhage: is the glass really half full? Crit Care Med 32:1431
- Roch A, Michelet P, Jullien AC, Thirion X, Bregeon F, Papazian L et al (2003) Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. Crit Care Med 31:2651–2656
- Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y et al (2016) Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PLoS ONE 11(12):e0168901
- Dijkers M, Gordon WA, Abreu B, Graham J, Charness A (2008) The intersection of aging/age and TBI: systematic review methodology. Brain Injury Prof 5:8–11
- Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963