# Prolonged intensive care therapy in nonagenarians admitted to the intensive care unit—clinical characteristics, risk factors and outcomes

## TL;DR

This study examines whether prolonged ICU treatment benefits nonagenarians, finding it is linked to higher mortality and limited long-term benefits.

## Contribution

The study identifies specific ICU factors associated with prolonged stays in patients aged 90+ and evaluates their clinical outcomes.

## Key findings

- Approximately 10% of nonagenarians had ICU stays of 7+ days, with higher mortality compared to shorter stays.
- Use of mechanical ventilation, vasopressors, and renal replacement therapy were significant predictors of prolonged ICU stays.
- Prolonged ICU treatment showed little long-term benefit and high mortality, suggesting careful consideration of care goals.

## Abstract

Intensive care unit (ICU) admissions of very elderly patients (≥90 years) have increased in recent years. To date, it remains unclear if prolonged ICU treatment (≥7 days) is justified regarding outcome. Yet, factors associated with prolonged ICU stay remain unknown in the very elderly critically ill population.

This retrospective study analysed all adult patients aged ≥90 years consecutively admitted to the ICU at a tertiary care centre in Hamburg, Germany, (01/01/2008–03/31/2019). Multivariable regression and Kaplan–Meier estimates were employed to assess the independent predictors of a prolonged ICU stay.

Of 1,091 very elderly patients admitted to the ICU, 10% (n = 110) experienced a prolonged ICU stay (≥7 days). Demographic characteristics, including age, gender, and body mass index (BMI)—were similar across groups. Patients with extended stays had higher admission SAPS II and SOFA scores (47 vs. 35 and 5 vs. 2 points, respectively, p < 0.001 for both). The requirement for mechanical ventilation (MV) and renal replacement therapy (RRT) was higher in the prolonged stay group (78 and 12%, respectively) compared to the shorter-stay group (30 and 2%, respectively, p < 0.001 for both). Multivariate regression analysis identified MV [OR 3.873, 95% CI (2.026–7.406); p < 0.001], vasopressors [OR 2.921, 95% CI (1.466–5.821); p = 0.002], RRT [OR 4.299, 95% CI (1.513–12.212); p = 0.006] and SAPS II [OR 1.023, 95% CI (1.004–1.043); p = 0.020] as independent intra ICU markers associated with a prolonged stay. ICU and hospital mortality rates were higher in the prolonged stay group (32 and 50%, respectively) compared to those with shorter stays (17 and 28%, respectively, p < 0.001 for all).

Approximately 10% of critically ill patients aged 90 years and above experienced prolonged ICU stays which was significantly associated with increased mortality. Prolonged ICU therapy has little long-term benefit and high mortality. Therefore, providing prolonged ICU treatment must be carefully considered incorporating individual frailty, premorbid function, and goals of care.