Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.
Details
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_9DFE0E072A0D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.
Journal
Intensive care medicine
Working group(s)
VIP2 and COVIP study groups
Contributor(s)
Eller P., Joannidis M., Mesotten D., Reper P., Oeyen S., Swinnen W., Brix H., Brushoej J., Villefrance M., Nedergaard H.K., Bjerregaard A.T., Balleby I.R., Andersen K., Hansen M.A., Uhrenholt S., Bundgaard H., Fjølner J., Hussein AARM, Salah R., Ali YKNEM, Wassim K., Elgazzar Y.A., Tharwat S., Azzam A.Y., Habib A.A., Abosheaishaa H.M., Azab M.A., Leaver S., Galbois A., Urbina T., Charron C., Guerot E., Besch G., Rigaud J.P., Maizel J., Djibré M., Burtin P., Garcon P., Nseir S., Valette X., Alexandru N., Marin N., Vaissiere M., Plantefeve G., Vanderlinden T., Jurcisin I., Megarbane B., Caillard A., Valent A., Garnier M., Besset S., Oziel J., Raphalen J.H., Dauger S., Dumas G., Goncalves B., Piton G., Barth E., Goebel U., Barth E., Kunstein A., Schuster M., Welte M., Lutz M., Meybohm P., Steiner S., Poerner T., Haake H., Schaller S., Schaller S., Schaller S., Kindgen-Milles D., Meyer C., Kurt M., Kuhn K.F., Randerath W., Wollborn J., Dindane Z., Kabitz H.J., Voigt I., Shala G., Faltlhauser A., Rovina N., Aidoni Z., Chrisanthopoulou E., Papadogoulas A., Gurjar M., Mahmoodpoor A., Ahmed A.K., Marsh B., Elsaka A., Sviri S., Comellini V., Rabha A., Ahmed H., Namendys-Silva S.A., Ghannam A., Groenendijk M., Zegers M., de Lange D., Cornet A.D., Evers M., Haas L., Dormans T., Dieperink W., Romundstad L., Sjøbø B., Andersen F.H., Strietzel H.F., Olasveengen T., Hahn M., Czuczwar M., Gawda R., Klimkiewicz J., Santos MLC, Gordinho A., Santos H., Assis R., Oliveira AIP, Badawy M.R., Perez-Torres D., Gomà G., Villamayor M.I., Mira A.P., Cubero P.J., Rivera S.A., Tomasa T., Iglesias D., Vázquez E.M., Aldecoa C., Ferreira A.F., Zalba-Etayo B., Canas-Perez I., Tamayo-Lomas L., Diaz-Rodriguez C., Sancho S., Priego J., Abualqumboz EMY, Hilles MMY, Saleh M., Ben-Hamouda N., Roberti A., Dullenkopf A., Fleury Y., Pinto B.B., Schefold J.C., Al-Sadaw M.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
04/2022
Peer-reviewed
Oui
Volume
48
Number
4
Pages
435-447
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST.
Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death.
693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients.
Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.
Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death.
693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients.
Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.
Keywords
COVID-19/therapy, Critical Care, Critical Illness, Humans, Intensive Care Units, Respiratory Insufficiency/therapy, SARS-CoV-2, COVID, Intensive care, Mortality, Old patients, Treatment limitation
Pubmed
Web of science
Open Access
Yes
Create date
03/03/2022 20:15
Last modification date
25/01/2024 7:41
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