Do Elderly Patients With Non-hematologic Malignancies Have A Worse Outcome in the ICU?
Accepted 23 June 2009.
Summary
Background
The aim of this study was to evaluate the difference in outcome between older (≥ 65 years) and younger (< 65 years) cancer patients admitted to the intensive care unit (ICU) with acute life-threatening illness.
Methods
A total of 1,881 patients were admitted to the medical intensive care unit (ICU) of Mackay Memorial Hospital, Taipei, from September 2004 to September 2007. We excluded patients diagnosed with cancer and in remission for > 5 years, ICU stay of < 24 hours, and ICU admission for routine postoperative monitoring. A total of 85 patients were included and divided into younger (< 65 years) and older (≥ 65 years) groups for comparison.
Results
The mean ages of the younger and older group were 50.7 ± 3.6 years and 76.1 ± 1.9 years, respectively. There was no significance in ICU length of stay (8.6 ± 2.5 days vs. 11.7 ± 2.6 days; p = 0.09), in the proportion of high Adult Comorbidity Evaluation 27 grade (86.1% vs. 77.6%; p = 0.32). The most frequent reasons for ICU admission in the younger and older groups were acute respiratory failure (50.0% vs. 61.2%) and shock (41.7% vs. 24.5%). The elderly had significantly more sepsis (87.8% vs. 58.3%; p = 0.002) and bloodstream or intraperitoneal infection (34.7% vs. 13.9%; p = 0.03), and received earlier conventional mechanical ventilation (−0.3 ± 0.17 days vs. 0.13 ± 0.36 days; p = 0.045) and shorter vasopressor administration (2.07 ± 0.94 days vs. 5.36 ± 2.63 days; p = 0.03). The hospital survival times in younger and older groups were 36.3 ± 16.3 days and 60.9 ± 33.9 days (p = 0.20), respectively, and 1-year survival rates were 2.8% and 12.2% (p = 0.12), respectively.
Conclusion
The main cause of death and survival rates, both short-term and long-term, were not worse in elderly patients with non-hematologic malignancies in the ICU, and the main reasons for patient death were sepsis and respiratory failure, rather than the malignancy itself. Therefore, an ICU admission policy should not exclude elderly patients with non-hematologic malignancies merely because of concerns about survival rate or life expectancy.
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aDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
bMackay Medicine, Nursing and Management College, Taipei, Taiwan
Correspondence to: Dr Chien-Liang Wu, Division of Thoracic and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan
ABSTRACT