Predictors of Intensive Care Unit Outcomes in Elderly Patients with Acute Respiratory Failure: A Retrospective Cohort Study.

<b>Background/Objectives</b>: Acute respiratory failure (ARF), a major cause of intensive care unit (ICU) admission in elderly patients, is strongly associated with adverse outcomes. Despite its clinical significance, data on prognostic factors in this patient group remain limited. This study aims to identify key prognostic factors in elderly ICU patients with ARF to guide clinical management. <b>Methods</b>: This retrospective cohort study analyzed data from elderly patients (≥65 years) admitted to the tertiary medical ICU of Gazi University Hospital due to ARF between February 2020 and December 2022. Collected data included demographic characteristics, comorbidities, reasons for ICU admission, organ support requirements, and clinical scores. Statistical analyses were performed to identify independent predictors of ICU mortality and invasive mechanical ventilation (IMV) requirement. <b>Results:</b> Of 244 patients, the median age was 76 (70-82) years, with a mortality rate of 49.2%. Independent predictors of mortality included higher SOFA scores (OR: 1.316, 95% CI: 1.089-1.590, <i>p</i> = 0.005), presence of shock at ICU admission (OR: 2.875, 95% CI: 1.046-7.905, <i>p</i> = 0.041), requirement of IMV (OR: 9.415, 95% CI: 3.591-24.679, <i>p</i> < 0.001), requirement of renal replacement therapy (RRT) (OR: 3.039, 95% CI: 1.125-8.206, <i>p</i> = 0.028), and hypoalbuminemia (OR: 3.647, 95% CI: 1.238-10.742, <i>p</i> = 0.019). IMV support was required in 56.9% of patients and was associated with more severe illness, worse oxygenation, and higher ICU mortality (77.6% vs. 11.4%, <i>p</i> < 0.001). <b>Conclusions</b>: In elderly patients with ARF, ICU mortality was independently associated with organ dysfunctions (higher SOFA scores, presence of shock at ICU admission, requirements of IMV and RRT) and hypoalbuminemia. Our findings highlight the need for individualized risk assessment and targeted supportive strategies in elderly patients with ARF.