Outcome of older patients requiring ventilatory support in intensive care:Impact of nutritional status

OBJECTIVES: To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivo rs 6 months after discharge. DESIGN: Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. SETTING: The ICU of a university hospital. PARTICIPANTS: One hundred sixteen consecutive patients age 70 and older adm itted to the ICU and treated by mechanical ventilation for at least 24 hour s. MEASUREMENTS: A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Funct ional status and residence were recorded for patients still living 6 months after discharge from the ICU. RESULTS: Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute phys iologic score corrected for points related to age (SAPS IIc). The predictor s of mortality at 6 months were a high omega score per day in the ICU, a hi gh SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile fo r the older French population in good health. Six months after discharge fr om the ICU, 91% of the surviving patients had the same residential status a nd 89% had a similar or improved functional status compared with pre-admiss ion status. CONCLUSIONS: Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we foun d that impaired nutritional status upon admission was related to 6-month mo rtality. These results emphasize the need for a systematic nutritional asse ssment in older patients admitted to the ICU and treated by mechanical vent ilation.