Question 8 from the second paper of 2007 discussed the influence of old age on ICU outcomes, and Question 23 from the second paper of 2007 brought up the issue of genetic susceptibility to various ICU-related illnesses. Other issues associated with actually measuring the outcomes are the topic for Question 25 from the first paper of 2013, but this got pushed into the Adminstration section.
In brief, it would be fair to say that old age makes everything worse for the ICU patient, and this is reflected in mortality data and functional outcomes following discharge. As for genetics... That question was done very poorly by the candidates, and since its appearance in 2007 the college have not revisited this area.
This was the subject of Question 8 from the second paper of 2007. The college answer to this question was slightly weird- they went on and on about various physiological changes associated with age (to be fair, most of these are adverse influences on outcome). Fortunately, there is an excellent article (de Rooij et al, 2005) which seems almost tailor-made to answer this question. Salient points from this article are summarised below:
The SAQ on this topic (Question 23 from the second paper of 2007) was passed by only 13% of the candidates, reflecting the fact that we are generally umprepared to discuss such trivial gibberish. Does one's lack of awareness within this topic diminish one's effectiveness as an ICU specialist? Perhaps. Tellingly, this question has never been repeated again, nor has it ever surfaced as a viva station. The time-poor exam candidate may safely abandon all reading on this topic.
In brief, the following specific associations between genotype and response to critical illness have been found:
In addition, the following comorbidities feature significantly in ICU outcomes, and have a known genetic basis:
de Rooij, Sophia E., et al. "Factors that predict outcome of intensive care treatment in very elderly patients: a review." Critical Care 9.4 (2005): R307.
Chung, T. Philip, et al. "Functional genomics of critical illness and injury." Critical care medicine 30.1 (2002): S51-S57.
Villar, Jesús, et al. "Bench-to-bedside review: understanding genetic predisposition to sepsis." Critical Care 8.3 (2004): 180.
Ely, E. Wesley, et al. "Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients*." Critical care medicine 35.1 (2007): 112-117.
Bion, J. F. "Susceptibility to critical illness: reserve, response and therapy."Intensive care medicine 26.1 (2000): S057-S063.
Bishehsari, Faraz, et al. "TNF-alpha gene (TNFA) variants increase risk for multi-organ dysfunction syndrome (MODS) in acute pancreatitis." Pancreatology 12.2 (2012): 113-118.
García-Laorden, M. Isabel, et al. "Influence of genetic variability at the surfactant proteins A and D in community-acquired pneumonia: a prospective, observational, genetic study." Crit Care 15.1 (2011): R57.
Holmes, Cheryl L., James A. Russell, and Keith R. Walley. "Genetic polymorphisms in sepsis and septic shock: role in prognosis and potential for therapy." CHEST Journal 124.3 (2003): 1103-1115.
Ely, E. Wesley, et al. "Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients*." Critical care medicine 35.1 (2007): 112-117.
Friedman, G., et al. "Apolipoprotein E-ε4 genotype predicts a poor outcome in survivors of traumatic brain injury." Neurology 52.2 (1999): 244-244.