TREATMENT MODALITIES AND THROMBOCYTOPENIA AFFECT MORTALITY IN ELDERLY ICU PATIENTS- OBSERVATIONAL STUDY IN TERTIARY CARE HOSPITAL IN NORTHERN INDIA

Ageing is a global phenomenon and number of patients admitted to Intensive Care Units (ICU) is increasing steadily. Number of studies assessing outcome in elderly South Asian patients in ICU is limited. Further research is necessary in this area so that the there is no bias in admitting the elderly in ICU especially in resource constrained units. Objective: Examine age-related difference in outcomes of ICU treatment in the elderly. Materials and Methods: A retrospective observational study was conducted in 100 patients admitted in a medical ICU (MICU) of a secondary care hospital over one year study period from September 2015 to September 2016. A clinical database was collected which included age, sex, SOFA (Sequential Organ Failure Assessment) scores, patient outcome, average length of ICU stay, admitting diagnosis and the treatment modalities used in ICU including mechanical ventilation (invasive and non-invasive), inotropes, renal replacement therapy (RRT), and tracheostomy. We divided patients into two groups i.e. less than 65 years (Control group) and greater than 65 years (Geriatric age group). Results: The observed overall ICU mortality rate in the study population was 27%. The overall mortality between the control and geriatric age group was not statistically significant (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.473, 95% confidence interval [CI] =0.290-0.743) and use of inotropes (P = 0.000, OR =8.500, 95% CI = 2.848-25.370), Renal Replacement therapy (P = 0.049, OR =3.343, 95% CI = 0.955-11.707)and platelet count <150 (P = 0.000, OR =5.630, 95% CI = 2.362-13.420)were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent modality predicting ICU mortality in the geriatric age group (? coefficient = 1.221, P = 0.000). SOFA score 11.77 ± 2.93 was associated with higher mortality. Non-invasive ventilation (NIV) is associated with better outcome in elderly as compared to invasive ventilation (P=0.002, OR=0.154, 95% CI=0.042-0.567.Conclusion: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation, inotropes, RRT and platelet count <150 during ICU stay. Only inotropic support could be identified as independent risk factor formortality. Thrombocytopenia is a simple and readily available marker for mortality which is independent of and complementary to established severity of disease indices in the elderly.