Journal of Medical and Surgical Intensive Care Medicine 2019 , Vol 10, Issue 2
Severe Acidemia, Leukocytosis and Low Hematocrit Levels at Admission as Mortality Predictors of Elderly Intensive Care Unit Patients
Türkay AKBAŞ 1 ,Elif ŞENOCAK TAŞCI 2 ,Hafize TİTİZ YILMAZTEPE 3 ,Feruze TURAN SÖNMEZ 4 ,Durdu Mehmet KÖS 5 ,Birgül ÖNEÇ 6
1Duzce University School of Medicine, Department of Internal Medicine, Duzce, Turkey
2Semdinli State Hospital, Hakkari, Turkey
3Sultan Murat 1. State Hospital, Internal Medicine, Edirne, Turkey
4Duzce University School of Medicine, Department of Emergency Medicine, Duzce, Turkey
5Occupational Diseases Hospital, Clinic of Internal Medicine, Ankara, Turkey
6Duzce University School of Medicine, Hematology Department, Duzce, Turkey
DOI : 10.33381/dcbybd.2019.2015 Aim: Rapid prediction of prognosis is helpful in reflecting the disease severity and patient mortality. This is especially important in critically ill elderly patients who have high mortality risk. This study aimed to investigate the effects of admission laboratory results and medical histories on the prediction of prognosis in critically ill elderly patients.

Material and Methods: Patients who were ≥65 years and admitted to a medical intensive care unit (ICU) between 2011 and 2013 were retrospectively analyzed.

Results: The study included 449 patients and mortality rate was 47.4%. Nonsurvivors had lower pH, HCO3 and albumin levels, and lower hematocrit and platelet counts, but higher aspartate aminotransferase, alanine aminotransferase, C-reactive protein (CRP), creatinine, phosphorus, magnesium and bilirubin levels, and higher leukocyte count than survivors. The rates of chronic kidney disease, being in a bedridden state and having cardiopulmonary resuscitation (CPR) before ICU admission were significantly high in nonsurvivors. Multivariate analysis showed that pH <7.20, albumin ≤2 gr/dL, low hematocrit and high CRP levels, high leukocyte count, bedridden state, and CPR were mortality predictors. After including the admission diagnoses and endotracheal intubation into the model, pH <7.20 (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.59-11.70), albumin ≤2 gr/dL (OR, 3.61; 95% CI, 0.99-13.03), hematocrit level (OR, 0.94; 95% CI, 0.91- 0.99) and leukocyte count (OR 1.06; 95% CI, 1.01-1.11) retained their prognostic importance for mortality.

Conclusions: Severe acidemia, low albumin and hematocrit levels, and high leukocyte count at admission help clinicians to foresee the prognosis in severely ill elderly patients. They keep their importance even in the presence of other fundamental mortality predictors. Keywords : Comorbidity, elderly patients, hypoalbuminemia, intensive care unit, pH, prognosis