Características clínicas e desfechos de pacientes com idade ≥ 90 anos internados em terapia intensiva: um estudo observacional e retrospectivo

Abstract

INTRODUCTION: Demographic transition has led to a progressive increase in the proportion of elderly and very elderly patients. This population shift implies a growing demand for health resources, including intensive care, despite the high mortality rates associated with this age group in ICUs. OBJECTIVES: To determine the clinical characteristics and outcomes of a population of very elderly patients (≥ 90 years old) admitted to the ICU, as well as predictive factors associated with mortality. METHODOLOGY: This retrospective observational study analyzed data from patients aged ≥ 90 years admitted to the Intensive Medicine Service of a tertiary hospital in São Luís - MA, between 2021 and 2022. Demographic, clinical, treatment, and outcome data were collected, using statistical analysis to determine independent predictors of mortality. RESULTS: Of the 3551 patients admitted, 269 (≥ 90 years old) were included. The majority were female (69.5%), with a high prevalence of comorbidities. The emergency department was the main origin of patient admission (87%). The most frequent diagnostic category upon ICU admission was infection/sepsis. The median duration of ICU stay was 7 days, and the median hospital stay was 15 days. Hospital mortality was 27.5%, and ICU mortality was 17.8%. The use of mechanical ventilation and dialysis on the first day of ICU was independently associated with higher mortality. CONCLUSION: Very elderly patients have a high prevalence of comorbidities, and specific interventions, such as mechanical ventilation and dialysis on the first day of ICU, are predictors of mortality. The observed mortality was not high compared to other case series, suggesting that chronological age alone should not be a criterion for limiting access to intensive care. Decisions on screening and treatment limitation are crucial in this population.