• Helene Vallet, Gabriele Leonie Schwarz, Hans Flaatten, Dylan W de Lange, Bertrand Guidet, and Agnes Dechartres.
• Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1135, Centre d'immunologie et de Maladies Infectieuses (CIMI), Department of Geriatrics, Saint Antoine hospital, Assistance Publique Hôpitaux de Paris (AP-HP), F75012 Paris, France.
• Crit. Care Med. 2021 Feb 1; 49 (2): 324334324-334.

ObjectivesTo conduct a systematic review of mortality and factors independently associated with mortality in older patients admitted to ICU.Data SourcesMEDLINE via PubMed, EMBASE, the Cochrane Library, and references of included studies.Study SelectionTwo reviewers independently selected studies conducted after 2000 evaluating mortality of older patients (≥ 75 yr old) admitted to ICU.Data ExtractionGeneral characteristics, mortality rate, and factors independently associated with mortality were extracted independently by two reviewers. Disagreements were solved by discussion within the study team.Data SynthesisBecause of expected heterogeneity, no meta-analysis was performed. We selected 129 studies (median year of publication, 2015; interquartile range, 2012-2017) including 17 based on a national registry. Most were conducted in Europe and North America. The median number of included patients was 278 (interquartile range, 124-1,068). ICU and in-hospital mortality were most frequently reported with considerable heterogeneity observed across studies that was not explained by study design or location. ICU mortality ranged from 1% to 51%, in-hospital mortality from 10% to 76%, 6-month mortality from 21% to 58%, and 1-year mortality from 33% to 72%. Factors addressed in multivariate analyses were also heterogeneous across studies. Severity score, diagnosis at admission, and use of mechanical ventilation were the independent factors most frequently associated with ICU mortality, whereas age, comorbidities, functional status, and severity score at admission were the independent factors most frequently associated with 3- 6 and 12 months mortality.ConclusionsIn this systematic review of older patients admitted to intensive care, we have documented substantial variation in short- and long-term mortality as well as in prognostic factors evaluated. To better understand this variation, we need consistent, high-quality data on pre-ICU conditions, ICU physiology and treatments, structure and system factors, and post-ICU trajectories. These data could inform geriatric care bundles as well as a core data set of prognostic factors to inform patient-centered decision-making.Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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