Neurologische Intensivtherapie bei alten Patienten

Zusammenfassung

Fragestellung: Indikationen, Aufnahmebefund und Langzeitprognose bei Patienten der neurologischen Intensivstation > 75 Jahre. Methode: Von 1/1997 - 6/2000 wurden 178 Patienten > 75 Jahre auf der neurologischen Intensivstation aufgenommen. Bei Aufnahme wurden GCS, prämorbider Rankin-Score (RS), Vitalzeichen und relevante Laborparameter analysiert. Das Outcome wurde bei Entlassung und nach mindestens einem Jahr untersucht. Ergebnisse: Das Alter der 178 Patienten (100 Frauen) betrug 79 ± 3,6 a. Der mediane GCS bei Aufnahme war 11. Häufigste Aufnahmeindikation war Schlaganfall (107 Patienten). 78 Patienten (44 %) wurden beatmet. Das mittlere Follow-up betrug 1082 ± 435 Tage. Die Mortalität bei Entlassung betrug 19 %, nach 30 Tagen 35 %, nach 6 Monaten 48 %, und im Langzeitverlauf 67 %. 30 Patienten (17 %) hatten ein gutes Outcome (RS 0 - 3). Assoziiert mit ungünstigem Outcome (Rankin > 3) waren Herzfrequenz, Blutzucker, Kreatinin, GCS, prämorbider RS, Leukozyten, Alter und Beatmung (p < 0,05). Schlaganfall war mit einem schlechteren Outcome assoziiert (p < 0,05). Schlussfolgerungen: Patienten der neurologischen Intensivstation > 75 Jahre haben eine hohe Mortalität. Ein gutes funktionelles Langzeitoutcome wird selten erreicht. Schlaganfallpatienten haben im Vergleich mit der Gesamtpopulation eine schlechtere Prognose.

Abstract

Purpose: To analyse indications, findings at admission, and the long-term prognosis in very elderly (> 75 years) neurocritical care patients. Methods: Between 1/1997 and 6/2000, 178 patients > 75 years were admitted to the neurocritical care unit. At admission, GCS, pre-morbid Rankin score, vital signs and relevant laboratory values were analysed. The outcome was evaluated at admission and after at least one year. Results: The mean age of all 178 patients (100 women) was 79 ± 3.6 years. The GCS on admission was 11 (3 - 15). The most frequent indication was stroke (107 patients). 78 patients (44 %) required intubation. At discharge, 34 patients (19 %) had died. The mortality rose to 35 % after 30 days, 48 % after 6 months, and to 67 % at the long-term follow-up examination after 1082 ± 435 days. 30 patients (17 %) had a good outcome (Rankin score < 4). Heart rate, blood glucose, serum creatinine, GCS, leukocytes, pre-morbid Rankin score, intubation, and age upon admission were associated with outcome (p < 0.05). Compared with all patients, patients with stroke had a poorer functional outcome (p < 0.05). Conclusions: The mortality in neurocritical care patients > 75 years is high. A favourable long-term outcome is rare. Stroke is associated with an even more unfavourable outcome.

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