Outcome of very old patients admitted to the ICU for sepsis : A systematic review

Background: Due to ageing of the general population, an increasing number of very old patients (>. 80. years old) is admitted to the hospital and to the intensive care unit (ICU). Sepsis is one of the most frequent reasons for admission. However, it is questioned whether admission of these very old intensive care patients (VOPs) is always indicated, as survival is generally poor. To enhance decision making, more information about chances of VOPs is of the utmost importance for the physicians, the patients and relatives and policymakers. Methods: A systematic search was performed in Medline and Embase up to 2017 to identify studies that described the outcome (either ICU-, hospital-mortality and/or any other short- or long-term outcome measure; e.g. 30-day mortality or one year mortality and also functional outcome and quality of life) of VOPs admitted for sepsis. Results: We identified 4562 potentially relevant publications, 18 studies could be included. In total, 4256 patients aged 80 years and older were incorporated in this systematic review. The median ICU-mortality was 43% [range 30-79%], the median hospital-mortality 47% [31-84%] and the median 1-year mortality 68% [53-83%]. Conclusions: Although relatively few studies are performed in VOPs admitted with sepsis, mortality rates seem to be high. Future studies are needed to identify factors that can predict survival and quality of life after discharge of VOPs in order to identify subgroups that benefit most from ICU treatment