Prognostic factors and scoring systems of elderly patients in intensive care unit

Objective: Considering the comorbidities and critical conditions of elderly patients in intensive care, predicting prognosis and mortality for these patients and regulating their treatments accordingly will be of vital importance for the patients. The results obtained from the study were aimed to provide benefits for improving the follow-up and treatment processes of critically ill elderly patients in intensive care services and reducing morbidity and mortality rates. In this study, we tried to determine the factors affecting and predicting the prognosis during intensive care follow-up of patients over 65 years of age. Materials and Methods: Data of patients aged 65 and over who were followed up in Akdeniz University Hospital Internal Medicine Intensive Care Unit between June 2022 and December 2023 were retrospectively examined. The necessary data were obtained by scanning patient files and hospital electronic database. Demographic data, medical history, hospital and intensive care unit stays, survival and mortality, treatments received during intensive care admission, and laboratory values of the patients were recorded. CRP and albumin values measured within the first 24 hours after admission to intensive care and in the last 24 hours before discharge from intensive care were recorded. The expressions 'Delta CRP' and 'Delta Albumin' were used to express the change in albumin and CRP values. SOFA and APACHE-II scores were calculated in the first 24 hours after admission to intensive care and in the last 24 hours before discharge from intensive care. The expressions 'Delta SOFA' and 'Delta APACHE' were used to express the change in SOFA and APACHE-II scores. The data obtained were compared in the surviving and deceased patient groups. Results: A total of 161 patients aged 65 and over who were monitored in intensive care were included in the study. As a result of the 45-day follow-up of the patients, it was seen that 83 (51.55%) exited and 78 (48.45%) survived. Associated with factors that increase the risk of mortality; The decrease in albumin levels increased the risk of death regardless of age and gender (p = 0.010). An increase in SOFA and APACHE scores increased the risk of mortality regardless of age and gender (p<0.001 for both). Independent of other factors, the presence of hematological malignancy increased the risk of mortality (p = 0.028). Being hospitalized in intensive care due to sepsis and receiving steroid treatment in intensive care increased the risk of mortality (p=0.007 and p=0.009, respectively). Increasing the length of intensive care stay increases the independent risk of mortality (p=0.009). . The decrease in SOFA and APACHE scores in elderly individuals monitored in intensive care increased the probability of survival (p<0.001 for both). Conclusion: Intensive care mortality is high in elderly patients. For elderly patients monitored in intensive care; Intensive care admission due to sepsis, presence of underlying hematological malignancy, increased duration of intensive care stay, decrease in albumin levels during follow-up, and receiving corticosteroid treatment during intensive care follow-up are independent factors that increase the risk of intensive care mortality. CRP, albumin levels, SOFA and APACHE-II scores measured at admission and exit to intensive care, blood transfusions and invasive mechanical ventilation during admission are significantly different in the surviving and deceased groups. These parameters may be useful in patient follow-up and treatment processes. An increase in delta SOFA and delta APACHE-II values is associated with an increased risk of intensive care mortality, regardless of age and gender. A decrease in SOFA and APACHE-II scores during follow-up is associated with an increased probability of survival. These parameters may provide clinical benefit in the follow-up of patients, prediction of prognosis and mortality, and evaluation of treatment response. Keywords: Elderly patient, critical care, prognosis and mortality