Background
Methods
Aim and design
Ethics
Hospital and RRT
Definitions
Data collection
Exclusion criteria
Statistical analysis
Results
Study cohort
Geriatric RRT patients vs. non-geriatric RRT patients
≥ 75 years (n = 449) | < 75 years (n = 923) |
p-value
| |
---|---|---|---|
Patient characteristics | |||
Age (median; Q1, Q3) | 82 (78, 85) | 63 (52, 69) | < 0.001 |
Sex (male) | 240 (54) | 581 (63) | 0.001 |
Medical patient | 155 (35) | 405 (44) | 0.001 |
CCI (median; Q1, Q3) | 2.0 (1.0, 4.0) | 2.0 (0.0, 3.0) | < 0.001 |
Coronary artery disease | 108 (24) | 102 (11) | < 0.001 |
Chronic heart failure | 124 (28) | 99 (11) | < 0.001 |
Peripheral artery disease | 55 (12) | 83 (9.0) | 0.063 |
Cerebrovascular disease | 86 (19) | 108 (12) | < 0.001 |
Diabetes | 112 (25) | 218 (24) | 0.620 |
Chronic obstructive pulmonary disease | 55 (12) | 100 (11) | 0.449 |
Renal insufficiency | 48 (11) | 77 (8.4) | 0.162 |
Malignancy | 117 (26) | 227 (25) | 0.579 |
Elective hospital admission | 345 (77) | 698 (76) | 0.621 |
Length of hospital admission (days, median; Q1, Q3) | 8 (4, 14) | 11 (6, 23) | < 0.001 |
Preceding ICU admission | 52 (12) | 198 (22) | < 0.001 |
Preceding LOMT | 38 (8.5) | 48 (5.2) | 0.019 |
Surgery 0–24 h before the review | 73 (16) | 107 (12) | 0.016 |
RRT review characteristics | |||
Days in hospital before the review (median; Q1, Q3) | 2 (1, 5) | 2 (1, 7) | 0.001 |
Review during on-call timea
| 340 (76) | 700 (76) | 0.963 |
Afferent limb failureb
| 128 (37) | 273 (36) | 0.650 |
Length of RRT review (min) (median; Q1, Q3) | 27 (20, 39) | 30 (20, 41) | 0.044 |
Reason for RRT activation | |||
• Respiratory | 156 (45) | 304 (40) | |
• Circulatory | 69 (20) | 142 (19) | |
• Neurologic | 47 (14) | 128 (17) | 0.297 |
• Multiple | 14 (4.1) | 38 (5.0) | |
• Otherc
| 59 (17) | 153 (20) | |
Vitals documented by RRT | |||
• AVPU ≤3 or GCS ≤ 13 | 129 (29) | 233 (25) | 0.176 |
• Heart rate < 40 or >140 /min | 42 (9.4) | 75 (8.1) | 0.452 |
• Systolic blood pressure < 90 mmHg | 61 (13) | 126 (14) | 0.962 |
• Respiratory rate < 5 or >24 /min | 175 (39) | 351 (38) | 0.757 |
• SpO2 < 90% | 139 (31) | 238 (26) | 0.047 |
• None of the above | 118 (26) | 246 (27) | 0.866 |
RRT intervention | |||
• Fluids | 165 (37) | 305 (33) | 0.175 |
• Oxygen | |||
o Intubation | 20 (4.5) | 48 (5.2) | |
o CPAP | 42 (9.4) | 105 (11) | 0.300 |
o Mask | 226 (50) | 417 (45) | |
• Medications | 100 (29) | 239 (31) | 0.450 |
New LOMT | 57 (13) | 43 (4.7) | < 0.001 |
Transfer to ICU | 69 (15) | 265 (29) | < 0.001 |
• ICU LOS (days, median; Q1, Q3) | 2 (1, 3) | 3 (1, 5) | 0.053 |
• Died in intensive care | 9/69 (13) | 31/265 (12) | 0.759 |
Patient outcome | ≥ 75 years (n = 449) | < 75 years (n = 923) |
p-value |
---|---|---|---|
New RRT review | 49 (11) | 177 (19) | < 0.001 |
24 h mortality | 37 (8.2) | 46 (5.0) | 0.018 |
Hospital mortality | 104 (23) | 158 (17) | 0.008 |
Discharged alive to | |||
• Homea
| 52 (15) | 296 (39) | |
• Other hospitalb
| 175 (51) | 302 (40) | < 0.001 |
• Primary care ward | 118 (34) | 167 (39) | |
30-day mortality | 148 (33) | 193 (21) | < 0.001 |
180-day mortality | 206 (46) | 281 (31) | < 0.001 |
One year mortality | 242 (54) | 323 (35) | < 0.001 |
Independent risk factors for 30-day mortality among the study cohort
Multivariate analysis | |||
---|---|---|---|
Odds ratio | 95% CI |
p-value | |
Preceding LOMT | 3.84 | 2.38–6.20 | < 0.001 |
Positive RRT criteria measured by RRT | 2.24 | 1.58–3.16 | < 0.001 |
CCI | 1.18 | 1.11–1.26 | < 0.001 |
Age > 75 years | 1.75 | 1.33–2.30 | < 0.001 |
Non-elective hospital admission | 1.99 | 1.40–2.83 | < 0.001 |
Preceding ICU admission | 0.64 | 0.44–0.95 | 0.025 |
Medical patient | 1.37 | 1.04–1.80 | 0.026 |
Afferent limb failure | 1.31 | 1.00–1.71 | 0.049 |
Surgery within 24 h | 0.74 | 0.48–1.15 | 0.180 |
Sex (male) | 1.16 | 0.88–1.52 | 0.278 |