Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

Wernly, Bernhard; Bruno, Raphael Romano; Frutos-Vivar, Fernando; Peñuelas, Oscar; Rezar, Richard; Raymondos, Konstantinos; Muriel, Alfonso; Du, Bin; Thille, Arnaud W; Ríos, Fernando; González, Marco; Del-Sorbo, Lorenzo; Marín, Maria Del Carmen; Pinheiro, Bruno Valle; Soares, Marco Antonio; Nin, Nicolas; Maggiore, Salvatore M; Bersten, Andrew; Kelm, Malte; Amin, Pravin; Cakar, Nahit; Young Suh, Gee; Abroug, Fekri; Jibaja, Manuel; Matamis, Dimitros; Zeggwagh, Amine Ali; Sutherasan, Yuda; Guidet, Bertrand; De Lange, Dylan W; Beil, Michael; Svri, Sigal; van Heerden, Vernon; Flaatten, Hans; Anzueto, Antonio; Osmani, Venet; Esteban, Andrés; Jung, Christian

BACKGROUND: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).