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Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

2022; Springer Science+Business Media; Volume: 48; Issue: 4 Linguagem: Inglês

10.1007/s00134-022-06642-z

1432-1238

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

Sepsis Diagnosis and Treatment

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.