Determinants of ICU Admission Care Limitation in Patients Younger Than 65 Years: A Prospective, Observational, Multicenter Study.

IMPORTANCE: Intensivists daily face ethics decisions regarding care limitation at admission (LA) or withholding life-sustaining therapy (WHLST) at admission, but no study focuses on patient younger than 65 years.

OBJECTIVES: To describe risk factors of care LA in patients younger than 65years.

DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter observational study in two western France ICUs was conducted among patients younger than 65 years with at least one organ failure. Two groups were identified: limited (LA or WHLST) or not limited care.

MAIN OUTCOMES AND MEASURES: The primary outcome was to identify risk factors for care LA. The secondary outcomes included mortality on days 28 and 90, hospital length of stay and outcomes parsed by care limitation modality.

RESULTS: Mean age for the 194 patients was 54.0 ± 9.2 years and 70 received an ICU care limitation decision at admission (40 LA, 30 WHLST). Care limited patients more often lived alone (47.1% vs. 31.5%, p = 0.044), had worse Clinical Frailty Score (CFS; 4 ± 2 vs. 2 ± 1, p < 0.001), were more opposed to care (24.3% vs. 4.0%, p < 0.001), had been hospitalized more frequently in the previous year (71.4% vs. 37.9%, p < 0.001), and had worse Charlson Comorbidity Index (CCI; 5 ± 3 vs. 2 ± 2, p < 0.001). CCI (odds ratio [OR] = 1.46; 95% CI, 1.20-1.79; p < 0.001), CFS (OR = 2.07; 95% CI, 1.51-2.84; p < 0.001), decision to contact a relative for decision-making (OR = 5.74; 95% CI, 2.15-15.34; p < 0.001) and patient's declination of care (OR = 7.58; 95% CI, 1.81-31.7; p = 0.005) were independent factors associated with care limitation. In contrast, Sequential Organ Failure Assessment score was unassociated (OR 0.94; 95% CI, 0.81-1.09; p = 0.435). Day-28 mortality was higher for care limited patients (58.6% vs. 17.7%, p < 0.001).

CONCLUSIONS AND RELEVANCE: Decision-making regarding LA or WHLST in critical patients younger than 65 years is influenced by comorbidity burden, family member involvement in decision-making, and the patient's willingness to undergo care, but not by organ failure intensity.