tetano
Editor, Senior Moderator
Intensive Care Med
. 2022 Feb 26.
doi: 10.1007/s00134-022-06642-z. Online ahead of print.
Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19
Bertrand Guidet[SUP] 1 2 [/SUP], Christian Jung[SUP] 3 [/SUP], Hans Flaatten[SUP] 4 5 [/SUP], Jesper Fjølner[SUP] 6 [/SUP], Antonio Artigas[SUP] 7 [/SUP], Bernardo Bollen Pinto[SUP] 8 [/SUP], Joerg C Schefold[SUP] 9 [/SUP], Michael Beil[SUP] 10 [/SUP], Sviri Sigal[SUP] 10 [/SUP], Peter Vernon van Heerden[SUP] 11 [/SUP], Wojciech Szczeklik[SUP] 12 [/SUP], Michael Joannidis[SUP] 13 [/SUP], Sandra Oeyen[SUP] 14 [/SUP], Eumorfia Kondili[SUP] 15 [/SUP], Brian Marsh[SUP] 16 [/SUP], Finn H Andersen[SUP] 17 18 [/SUP], Rui Moreno[SUP] 19 [/SUP], Maurizio Cecconi[SUP] 20 [/SUP], Susannah Leaver[SUP] 21 [/SUP], Dylan W De Lange[SUP] 22 [/SUP], Ariane Boumendil[SUP] 23 24 [/SUP], VIP2 and COVIP study groups
Collaborators, Affiliations
Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
. 2022 Feb 26.
doi: 10.1007/s00134-022-06642-z. Online ahead of print.
Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19
Bertrand Guidet[SUP] 1 2 [/SUP], Christian Jung[SUP] 3 [/SUP], Hans Flaatten[SUP] 4 5 [/SUP], Jesper Fjølner[SUP] 6 [/SUP], Antonio Artigas[SUP] 7 [/SUP], Bernardo Bollen Pinto[SUP] 8 [/SUP], Joerg C Schefold[SUP] 9 [/SUP], Michael Beil[SUP] 10 [/SUP], Sviri Sigal[SUP] 10 [/SUP], Peter Vernon van Heerden[SUP] 11 [/SUP], Wojciech Szczeklik[SUP] 12 [/SUP], Michael Joannidis[SUP] 13 [/SUP], Sandra Oeyen[SUP] 14 [/SUP], Eumorfia Kondili[SUP] 15 [/SUP], Brian Marsh[SUP] 16 [/SUP], Finn H Andersen[SUP] 17 18 [/SUP], Rui Moreno[SUP] 19 [/SUP], Maurizio Cecconi[SUP] 20 [/SUP], Susannah Leaver[SUP] 21 [/SUP], Dylan W De Lange[SUP] 22 [/SUP], Ariane Boumendil[SUP] 23 24 [/SUP], VIP2 and COVIP study groups
Collaborators, Affiliations
- PMID: 35218366
- DOI: 10.1007/s00134-022-06642-z
Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
