Admission characteristics and factors associated with outcomes in elderly patients aged 75 years and older in a level 3 ICU in Nepal: a 4-year registry-based retrospective study.

BACKGROUND: The global rise in elderly populations has led to increasing admissions of older adults to intensive care units (ICUs). Understanding predictors of mortality in the very elderly is essential, particularly in low- and middle-income countries (LMICs) where ICU resources are limited. METHODS: This retrospective observational study analyzed 1,028 ICU patients aged ≥75 years admitted to a level 3 ICU in Nepal. Demographics, comorbidities, frailty score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, interventions, and outcomes were collected. Univariate analysis, bivariate analysis, and multivariate logistic regression were used for statistical analysis to determine independent predictors of ICU mortality. RESULTS: The cohort had a mean age of 82±5 years and 58.1% were male. ICU mortality was 17.5%. Non-survivors were older and had higher APACHE II scores, more comorbidities, and a greater requirement for mechanical ventilation and vasopressors than survivors. Logistic regression identified age (adjusted odds ratio [aOR], 1.05), comorbidity burden (aOR, 1.40), APACHE II score (aOR, 1.08), mechanical ventilation (aOR, 2.10), and the use of vasopressors (aOR, 1.80) as independent predictors of mortality. Frailty, sex, aggressiveness of therapy, and primary system involvement were not independently associated with ICU mortality. CONCLUSIONS: Age, comorbidity burden, and organ support requirements strongly predicted mortality among elderly ICU patients in Nepal. These findings support early risk stratification, prognostic assessment, and informed clinical discussions in resource-limited ICU settings.