Selected Publication:

SHR Neuro Cancer Cardio Lipid Metab Microb

Guidet, B; Jung, C; Flaatten, H; Fjølner, J; Artigas, A; Pinto, BB; Schefold, JC; Beil, M; Sigal, S; van, Heerden, PV; Szczeklik, W; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, FH; Moreno, R; Cecconi, M; Leaver, S; De, Lange, DW; Boumendil, A, , VIP2, and, COVIP, study, groups.
Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.
Intensive Care Med. 2022; Doi: 10.1007/s00134-022-06642-z [OPEN ACCESS]
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Eller Philipp

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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.

Find related publications in this database (Keywords)

Old patients

COVID

Intensive care

Treatment limitation

Mortality

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