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The Independent Impact of Peripheral Arterial Disease on Mortality in Nonagenarians and Centenarians Who Were Treated in an Intensive Care Unit: A Consecutive Cohort of 1 108 Patients

  • Kevin Roedl
    Affiliations
    Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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  • Rikus Daniels
    Affiliations
    Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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  • Pauline Theile
    Affiliations
    Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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  • Stefan Kluge
    Affiliations
    Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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  • Author Footnotes
    1 Jakob Müller and Christian-Alexander Behrendt contributed equally.
    Jakob Müller
    Footnotes
    1 Jakob Müller and Christian-Alexander Behrendt contributed equally.
    Affiliations
    Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Department of Anaesthesiology, Tabea Hospital, Hamburg, Germany
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  • Author Footnotes
    1 Jakob Müller and Christian-Alexander Behrendt contributed equally.
    Christian-Alexander Behrendt
    Correspondence
    Corresponding author. Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
    Footnotes
    1 Jakob Müller and Christian-Alexander Behrendt contributed equally.
    Affiliations
    Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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  • Author Footnotes
    1 Jakob Müller and Christian-Alexander Behrendt contributed equally.
Open AccessPublished:January 19, 2023DOI:https://doi.org/10.1016/j.ejvs.2023.01.026
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      Abstract

      Objective

      To investigate the clinical characteristics, risk factors, and outcomes of inpatients with peripheral arterial disease (PAD) including lower extremity PAD, abdominal aortic aneurysm (AAA), and carotid artery disease in a large cohort of critically ill patients aged ≥ 90 years.

      Methods

      A retrospective analysis was conducted of all adult patients aged ≥ 90 years consecutively admitted to the intensive care unit at a tertiary care centre in Hamburg, Germany, between 1 January 2008 and 30 April 2019. Multivariable regression and Kaplan–Meier methods were used to determine the independent impact of PAD on short term and long term mortality endpoints. The analyses were adjusted for confounding by several sociodemographic and clinical parameters including Charlson Comorbidity Index (CCI) and established clinical risk scores.

      Results

      A total of 1 108 eligible patients were identified (92.3 years, 33% men). Of these, 24% had PAD (9% lower extremity PAD, 2% AAA, 15% coronary artery disease) and 76% did not have any history of PAD and were used as a comparison group. When compared with the comparison group, patients with PAD had a higher CCI (2 vs. 1, p < .001), more often chronic kidney disease (28% vs. 21%, p = .019), and renal replacement therapy (5% vs. 2%, p = .016). Furthermore, they needed vasopressors (48% vs. 40%, p = .027) and parenteral nutrition (10% vs. 6%, p = .041) more often. After adjusting for confounding, PAD was independently associated with increased in hospital (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.39 – 2.81, p < .001) and long term mortality (HR 1.32, 95% CI 1.05 – 1.66, p = .019).

      Conclusion

      One out of four critically ill nonagenarians and centenarians in an ICU in Germany had PAD. PAD was associated with both higher short and long term mortality while its impact outweighed higher age. Future studies should address this increasingly important population beyond 89 years of age.

      Keywords

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