The impact of aging on outcomes in acute respiratory distress syndrome: a multicenter cohort study

Huang, Alexander A.1; Huang, Samuel Y.2,*

1Department of MD Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

2Department of Internal Medicine, Icahn School of Medicine at Mount Sinai South Nassau, Oceanside, NY, USA

*Correspondence to: Samuel Huang, MD, Samuel.huang@mssm.edu.

Abstract

Advanced age significantly influences outcomes in acute respiratory distress syndrome, with implications for intensive care unit-free days, ventilator-free days, and mortality. Understanding these relationships is essential for optimizing care in elderly populations. This retrospective multicenter cohort study included 1992 patients with acute respiratory distress syndrome from the Acute Respiratory Distress Syndrome Network trials, specifically the ALTA (Albuterol for the Treatment of Acute Lung Injury), EDEN (Early vs. Delayed Enteral Nutrition), Omega (Omega-3 Fatty Acid, Gamma-Linolenic Acid, and Anti-Oxidant Supplementation), and SAILS (Statins for Acutely Injured Lungs from Sepsis) studies, categorized into four age groups: < 40 years (n = 450, 22.6%), 40–60 years (n = 915, 45.9%), 60–80 years (n = 536, 26.9%), and > 80 years (n = 91, 4.6%). Key demographic characteristics, including gender, race, and ethnicity, were analyzed. Regression models adjusted for driving pressure and PaO₂/FiO₂ ratio examined associations between age and intensive care unit-free days, ventilator-free days, and mortality at 60 and 90 days. The results showed that older age was correlated with significantly fewer intensive care unit-free days and ventilator-free days and higher mortality. Patients > 80 years experienced 8.47 fewer intensive care unit-free days (95% CI: –11.24 to –5.69) and 9.26 fewer ventilator-free days (95% CI: –12.22 to –6.31) compared to those < 40 years. Mortality increased with age; 60-day mortality odds ratios were 1.44 (95% CI: 1.02–1.88) for 60–80 years and 2.32 (95% CI: 1.66–3.00) for > 80 years. Results persisted at 90 days. Subgroup analysis revealed demographic disparities: non-Hispanic White patients comprised 77.3%, Black patients 15.4%, and Hispanic ethnicity 11.6%. Men accounted for 50.9% of the cohort. The findings suggest that aging significantly worsens acute respiratory distress syndrome outcomes, with reductions in intensive care unit-free days, ventilator-free days, and survival. Older patients warrant targeted management strategies, emphasizing ventilatory optimization, particularly driving pressure and oxygenation indices, to improve outcomes. These findings underscore the need for personalized approaches to acute respiratory distress syndrome management in elderly populations.

衰老对急性呼吸窘迫综合征结局的影响：多中心队列研究

摘要

衰老对急性呼吸窘迫综合征的预后有很大影响，对重症监护室无呼吸机天数、无呼吸机天数和死亡率都有影响。了解这些关系对于优化老年人群的护理至关重要。这项回顾性多中心队列研究纳入了急性呼吸窘迫综合征网络试验中的1992 例急性呼吸窘迫综合征患者，特别是 ALTA（治疗急性肺损伤的阿布特罗）、EDEN（早期与延迟肠内营养）试验中的患者。延迟肠内营养）、Omega（Omega-3 脂肪酸、二十二碳六烯酸和二十碳五烯酸）和 SAILS（治疗败血症急性肺损伤的他汀类药物）研究，分为4个年龄组： < 小于 40 岁（450 例，占 22.6%）、40-60 岁（915例，占 45.9%）、60-80 岁（536例，占 26.9%）和> 80 岁（91例，占 4.6%）。对包括性别、种族和民族在内的主要人口特征进行了分析。根据驾驶压力和 PaO₂/FiO₂比值调整的回归模型检验了年龄与无重症监护室天数、无呼吸机天数以及 60 天和 90 天死亡率之间的关系。结果显示，年龄越大，无重症监护室天数和无呼吸机天数越少，死亡率越高。与年龄小于40岁的患者相比，年龄大于80岁的患者无重症监护室天数减少8.47天（95% CI：-11.24至-5.69），无呼吸机天数减少9.26天（95% CI：-12.22至-6.31）。死亡率随年龄增长而增加；60-80 岁患者的60天死亡率几率比为 1.44（95% CI：1.02-1.88），大于80岁患者的几率比为 2.32（95% CI：1.66-3.00）。结果在90天后仍然存在。分组分析显示了人口统计学差异：非西班牙裔白人患者占 77.3%，黑人患者占 15.4%，西班牙裔患者占 11.6%。男性占 50.9%。研究结果表明，衰老会显著恶化急性呼吸窘迫综合征的预后，减少无重症监护室天数、无呼吸机天数和存活率。老年患者需要有针对性的管理策略，强调通气优化，尤其是驱动压力和氧合指数，以改善预后。这些发现强调了对老年急性呼吸窘迫综合征进行个性化管理的必要性。

关键词：急性呼吸窘迫综合征；老龄化；衰老；老年医学；无重症监护室天数；死亡率；无呼吸机天数