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The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

2021; BioMed Central; Volume: 25; Issue: 1 Linguagem: Inglês

10.1186/s13054-021-03551-3

1466-609X

Christian Jung, Hans Flaatten, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sigal Sviri, Peter Vernon van Heerden, Wojciech Szczeklik, Mirosław Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H. Andersen, Rui P. Moreno, Maurizio Cecconi, Susannah Leaver, Ariane Boumendil, Dylan W. de Lange, Bertrand Guidet, Hans Flaatten, Bernhard Wernly, Antonio Artigas, Michael Beil, Sigal Sviri, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Tilemachos Zafeiridis, Rui P. Moreno, Maurizio Cecconi, Ariane Boumendil, Hazem Abosheaishaa, Enas M. Y. Abualqumboz, Abdullah Khudhur Ahmed, Hazem A. Sayed Ahmed, Zoi Aidoni, César Aldecoa, Nica Alexandru, Yasmin Khairy NasrEldin Mohamed Ali, Mohammed Al‐Sadawi, Kasper Andersen, Finn H. Andersen, Rui Assis, Mohammed A. Azab, Ahmed Y. Azzam, Mohamed Raafat Badawy, Ida Riise Balleby, Eberhard Barth, Eberhard Barth, Nawfel Ben‐Hamouda, Guillaume Besch, Sébastien Besset, Anders Thais Bjerregaard, Helene Brix, Raphael Romano Bruno, Jens Brushoej, Henning Bundgaard, Philippe Burtin, Anaïs Caillard, Isabel Canas-Pérez, Cyril Charron, Evangelia Chrisanthopoulou, Vittoria Comellini, Alex Cornet, Patricia Jimeno Cubero, Mirosław Czuczwar, Stéphane Dauger, Cristina Díaz-Rodríguez, Willem Dieperink, Zouhir Dindane, Michel Djibré, Tom Dormans, Alexander Dullenkopf, Guillaume Dumas, Yumna A Elgazzar, Philipp Eller, Ahmed Elsaka, Mirjam Evers, Andreas Faltlhauser, Aida Fernández Ferreira, Jesper Fjølner, Yvan Fleury, Arnaud Galbois, Pierre Garçon, Marc Garnier, Ryszard Gawda, Abdelilah Ghannam, Hans H. Goebel, Gemma Gomà, Bruno Gonçalves, André Gordinho, Martijn Groenendijk, Emmanuel Guérot, Bertrand Guidet, Mohan Gurjar, Hendrik Haake, Lenneke Haas, Ayman Abdelmawgoad Habib, Michael Hahn, Maria Aagaard Hansen, Momin Majed Yousuf Hilles, Aliaë Mohamed-Hussein, David A. Iglesias, Michael Joannidis, Christian Jung, Igor Jurcisin, Hans‐Joachim Kabitz, Malte Kelm, Detlef Kindgen‐Milles, Jakub Klimkiewicz, Karl Friedrich Kuhn, Anselm Kunstein, Muhammed Kurt, Dylan W. de Lange, Susannah Leaver, Matthias Lutz, Ata Mahmoodpoor, Julien Maizel, Nathalie Marin, Brian Marsh, Buno Mégarbane, Dieter Mesotten, Patrick Meybohm, Christian Meyer, Ángela Prado Mira, Silvio A. Ñamendys‐Silva, Helene Korvenius Nedergaard, Saad Nseir, Sandra Oeyen, Theresa M. Olasveengen, Ana Andrade Oliveira, Johanna Oziel, Antonio Artigas, David Pérez-Torres, Bernardo Bollen Pinto, Gaël Piton, Gaëtan Plantefève, Tudor C. Poerner, Jesús Priego, Ahmed Rabha, Winfried Randerath, Jean-Herlé Raphaelen, P. Reper, Jean‐Philippe Rigaud, S. Arias-Rivera, Andrea Roberti, Luis Romundstad, Νikoletta Ρovina, Rehab Salah, Mahmoud Saleh, Susana Sancho, Lurdes Santos, Lurdes Santos, Stefan J. Schaller, Joerg C. Schefold, Michael Schuster, Gonxhe Shala, Britt Sjøbø, Stephan Steiner, Hans Frank Strietzel, Sigal Sviri, Walter Swinnen, Luis Tamayo-Lomas, Samar Tharwat, Teresa Tomasa, Stine Uhrenholt, Marie Vaissiere, Arnaud Valent, Xavier Valette, Thierry Vanderlinden, Eric Mayor Vázquez, Mercedes Ibarz Villamayor, Maja Villefrance, Ingo Voigt, Kyrillos Wassim, M. Welte, Georg Wolff, Jakob Wollborn, Begoña Zalba-Etayo, Marieke Zegers,

Intensive Care Unit Cognitive Disorders

Abstract Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients ( p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.