Parkinson Disease Lengthens ICU Stays, but Does Not Increase Mortality

People with Parkinson disease (PD) who get admitted to hospital intensive care units (ICUs) tend to be admitted with higher severity scores and stay longer in the unit, but their overall mortality does not differ significantly from the general patient population, according to new research.

The results were published in the journal Parkinson’s Disease by corresponding author Álvaro Réa-Neto, PhD, of the Center for Studies and Research in Intensive Care Medicine in Brazil.

About 1% of adults over the age of 60 will be diagnosed with PD. But even as the disease becomes more prevalent, people with PD are living longer due to improved health care and treatment options.

Previous research has indicated that patients with PD are more likely to be admitted to the hospital and have longer stays once they are admitted. Those hospital stays contribute to higher health care utilization and costs among patients with the disease. Yet, Réa-Neto and colleagues said there have not been many recent studies looking at the costliest category of hospital admission, ICU admission, among patients with PD.

The investigators decided to compare ICU admission data from patients with PD to data from patients without the disease. They focused on a cohort of patients with PD who were over the age of 18 and were admitted to the ICU in a Brazilian city between 2001 and 2019. Those patients were then matched on a 2:1 ratio by demographic data and year with patients without PD. All told, they found 231 ICU admissions of patients with PD and they identified 462 matched controls.

The data showed that the most common reason patients with PD were admitted to the ICU was sepsis or trauma, which together made up about half of admissions in the PD group. Just 16.5% of patients with PD were sent to the ICU for a morbidity directly related to their PD.

Upon ICU admission, the data showed patients with PD typically had lower consciousness levels (according to Glasgow scores) and increased APACHE II severity scores, compared with patients without PD.

Réa-Neto and colleagues said there are many reasons why people with neurodegenerative diseases might require more health care utilization.

“Patients with neurodegenerative diseases become increasingly frail with age, which leads to a rapid deterioration of the patient's condition with any new clinical complication, resulting in longer hospital stay, greater requirement for invasive ventilatory support, and increased risk of complications and death,” the authors wrote.

However, in this particular study, the authors said, there were no statistically significant differences between the PD group and the control group in terms of the need for invasive ventilatory support or mortality. Even when investigators stratified patients based on the cause of their hospitalization and controlled for variables of disease severity, they could not find a statistically significant increased risk of death among patients with PD.

The lack of an increased risk of mortality in the ICU for patients with PD aligns with earlier studies in Canada and India, the authors said. Yet, despite the lack of an increased risk of mortality, the authors found patients with PD still required longer stays in the ICU.

The study has some limitations, Réa-Neto and colleagues noted. Among them, the investigators did not assess the severity of the patients’ PD, nor did they factor in the length of time the patients had had the disease.

Still, they said the study provides important insights into the ways in which PD does—and does not—affect patients.

Reference:

Réa-Neto Á, Dal Vesco BC, Bernardelli RS, Kametani AM, Oliveira MC, Teive HAG. Evaluation of patients with Parkinson's disease in intensive care units: a cohort study. Parkinsons Dis. Published online November 5, 2021. doi:10.1155/2021/2948323