Dados do Trabalho

Título

Persistent critical illness and long-term outcomes of elderly patients with community-acquired pneumonia

Objetivo

Our aim was to investigate whether persistent critical illness (PIC) in elderly patients with CAP is associated with poor long-term outcomes.

Métodos

We conducted a retrospective cohort study of elderly patients admitted to 11 Brazilian ICU between January1 and December31, 2023. We included 60y and older with a CAP primary diagnosis. The exclusion criteria were readmission, transfer from other hospitals, and incomplete hospital outcomes. PIC was defined ≥10days of ICU Length-of-stay (LoS). Mortality data were obtained from the ICU and public records. Survival curves (6-month mortality) are presented and compared.

Resultados

Of the 10,487 hospitalizations, 818 elderly patients had CAP. Of 402 patients who remained in the hospital after ten days, two groups were evaluated: the PIC group (N=112) and the non-PIC group (N=290). The two groups had similar baseline clinical characteristics. Resource use (mechanical ventilation, renal replacement therapy and tracheostomy) were more frequent for PIC than non-PIC group, Hospital LoS (22days IQR16;39 vs 15days IQR11;23 respectively), and 180 days survival rates (45,3% vs 23,4% respectively) were significantly different. The mortality curve was visually more inclined until 60 days, more prominently in the PIC group. Interestingly, excessive deaths in the PIC group occurred during ICU stay. Sequentially, the pattern of death distribution (in-hospital or post-hospital discharge) was similar between the groups.

Conclusão

This study sheds light on the long-term survival implications of extended ICU stays for elderly patients with CAP. Our findings support more informed and timely family meetings to discuss the purpose and intensity of ICU care for PIC patient.