RESUMO
BACKGROUND: This study aimed to analyze the predictive effect of various inflammatory indices and inflammatory biomarkers on prognosis after coronary artery bypass grafting (CABG). METHODS: In this retrospective observational study, data were recorded from 99 patients who underwent isolated elective CABG between January 2019 and June 2021 and met the inclusion criteria. The patients were divided into two main groups according to the postoperative clinical results: "favorable outcome" and "poor outcome." Preoperative inflammatory parameters, inflammatory indices (such as systemic inflammation index (SII), neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR)), and clinical variables were compared between the groups. RESULTS: Poor postoperative outcomes developed in 31 (31.3%) patients. In the univariate analysis, white blood cell count (p=0.008), neutrophil count (p=0.002), SII (p=0.018), NLR (p=0.003), and dNLR (p=0.003) were found to be significant predictors for poor outcomes. In the multivariate analysis, only the presence of chronic obstructive pulmonary disease (COPD) (OR=8.765; 95% CI 1.308-58.702; p=0.025) and high creatinine levels (OR=1.049; 95% CI 1.005-1.094; p=0.027) were independent risk factors for poor outcomes. Optimal cut-off values were 603.08 (areas under the curve (AUC)=0.632, p=0.036) for SII, 2.34 (AUC=0.669, p=0.007) for NLR, and 1.76 (AUC=0.667, p=0.008) for dNLR. CONCLUSION: SII, NLR, dNLR, and inflammatory markers, such as white blood cell and neutrophil counts, are feasible markers for predicting poor outcomes following CABG procedures. These parameters may aid in the development of early therapeutic interventions to improve patient outcomes.
RESUMO
BACKGROUND: In this study, we aim to describe clinical features and outcomes of very elderly (85 years old or older) patients and provide information about predictors of mortality and factors associated with the length of hospital stay (LOS). MATERIALS AND METHODS: We reviewed retrospectively the files of patients over 85 years old and older who were admitted to the intensive care unit (ICU) of our training and research hospital between January 2017 and December 2018. Demographic and clinical findings, treatment modalities, and outcomes were recorded. The patients who died during the ICU stay were compared to the survivors, and factors associated with mortality and LOS in the intensive care were evaluated. RESULTS: We reviewed 2350 files, and 218 patients (58.3% females) were included. The rate of mortality was 81.7%. The factors independently associated with a higher rate of mortality were the acute physiology and chronic health evaluation (APACHE) II score; the need for mechanical ventilation (MV), or inotropic support; and the presence of coronary artery disease (CAD) or chronic kidney disease (CKD). A tracheostomy and a blood transfusion were inversely associated with mortality. We found an association between LOS and comorbidities (renal replacement, percutaneous gastrostomy, blood transfusion, and a tracheostomy). CONCLUSION: The rate of survival in the intensive care was low among these very elderly intensive care patients. A higher APACHE II score; application of MV or inotropic support; and the presence of CAD or CKD were associated with a higher mortality rate. HOW TO CITE THIS ARTICLE: Miniksar OH, Özdemir M. Clinical Features and Outcomes of Very Elderly Patients Admitted to the Intensive Care Unit: A Retrospective and Observational Study. Indian J Crit Care Med 2021; 25(6):629-634.
