Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU

Oded Mousai, Lola Tafoureau, Tamar Yovell, Hans Flaatten, Bertrand Guidet, Christian Jung, Dylan de Lange, Susannah Leaver, Wojciech Szczeklik, Jesper Fjolner, Peter Vernon van Heerden, Leo Joskowicz, Michael Beil, Gal Hyams, Sigal Sviri*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Purpose: The biological and functional heterogeneity in very old patients constitutes a major challenge to prognostication and patient management in intensive care units (ICUs). In addition to the characteristics of acute diseases, geriatric conditions such as frailty, multimorbidity, cognitive impairment and functional disabilities were shown to influence outcome in that population. The goal of this study was to identify new and robust phenotypes based on the combination of these features to facilitate early outcome prediction. Methods: Patients aged 80 years old or older with and without limitations of life-sustaining treatment and with complete data were recruited from the VIP2 study for phenotyping and from the COVIP study for external validation. The sequential organ failure assessment (SOFA) score and its sub-scores taken on admission to ICU as well as demographic and geriatric patient characteristics were subjected to clustering analysis. Phenotypes were identified after repeated bootstrapping and clustering runs. Results: In patients from the VIP2 study without limitations of life-sustaining treatment (n = 1977), ICU mortality was 12% and 30-day mortality 19%. Seven phenotypes with distinct profiles of acute and geriatric characteristics were identified in that cohort. Phenotype-specific mortality within 30 days ranged from 3 to 57%. Among the patients assigned to a phenotype with pronounced geriatric features and high SOFA scores, 50% died in ICU and 57% within 30 days. Mortality differences between phenotypes were confirmed in the COVIP study cohort (n = 280). Conclusions: Phenotyping of very old patients on admission to ICU revealed new phenotypes with different mortality and potential need for anticipatory intervention.

Original languageAmerican English
Pages (from-to)1726-1735
Number of pages10
JournalIntensive Care Medicine
Volume48
Issue number12
DOIs
StatePublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

  • Clustering analysis
  • Geriatric patients
  • Heterogeneity
  • Intensive care
  • Phenotyping

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