Document Detail


End-stage renal disease status and critical illness in the elderly.
MedLine Citation:
PMID:  21127136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Elderly patients (> 65 years old) are a rapidly growing demographic in the ESRD and intensive care unit (ICU) populations, yet the effect of ESRD status on critical illness in elderly patients remains unknown. Reliable estimates of prognosis would help to inform care and management of this frail and vulnerable population.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The effect of ESRD status on survival and readmission rates was examined in a retrospective cohort of 14,650 elderly patients (>65 years old) admitted to 11 ICUs in Winnipeg, Manitoba, Canada between 2000 and 2006. Logistic regression models were used to adjust odds of mortality and readmission to ICU for baseline case mix and illness severity.
RESULTS: Elderly ESRD patients had twofold higher crude in-hospital mortality (22% versus 13%, P < 0.0001) and readmission rate (6.4 versus 2.7%, P = 0.001). After adjustment for illness severity alone or illness severity and case mix, the odds ratio for mortality decreased to 0.85 (95% CI: 0.57 to 1.25) and 0.82 (95% CI: 0.55 to 1.23), respectively. In contrast, ESRD status remained significantly associated with readmission to ICU after adjustment for other risk factors (OR 2.06 [95% CI: 1.32, 3.22]).
CONCLUSIONS: Illness severity on admission, rather than ESRD status per se, appears to be the main driver of in-hospital mortality in elderly patients. However, ESRD status is an independent risk factor for early and late readmission, suggesting that this population might benefit from alternative strategies for ICU discharge.
Authors:
Manish M Sood; Dan Roberts; Paul Komenda; Joe Bueti; Martina Reslerova; Julie Mojica; Claudio Rigatto
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-12-02
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-17     Completed Date:  2011-06-30     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  613-9     Citation Subset:  IM    
Affiliation:
Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Aging*
Analysis of Variance
Chi-Square Distribution
Critical Illness
Female
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data*
Kidney Failure, Chronic / diagnosis,  mortality*,  therapy
Logistic Models
Male
Manitoba / epidemiology
Odds Ratio
Patient Readmission / statistics & numerical data*
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Survival Analysis
Time Factors
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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