Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

• Author(s): Guidet, B ; Jung, C ; Flaatten, H ; Fjølner, J ; Artigas, A ; Bollen Pinto, B ; Schefold, J ; Beil, M ; Sigal, S ; Vernon van Heerden, P ; Szczeklik, W ; Joannidis, M ; Oeyen, S ; Kondili, E ; Marsh, B ; Andersen, F ; Moreno, R ; Cecconi, M ; Leaver, S ; De Lange, D ; Boumendil, A ; Eller, P ; Joannidis, M ; Mesotten, D ; Reper, P ; Oeyen, S ; Swinnen, W ; Brix, H ; Brushoej, J ; Villefrance, M ; Nedergaard, H ; Bjerregaard, A ; Balleby, I ; Andersen, K ; Hansen, M ; Uhrenholt, S ; Bundgaard, H ; Fjølner, J ; Hussein, A ; Salah, R ; Ali, Y ; Wassim, K ; Elgazzar, Y ; Tharwat, S ; Azzam, A ; Habib, A ; Abosheaishaa, H ; Azab, M ; Leaver, S ; Galbois, A ; Urbina, T ; Charron, C ; Guerot, E ; Besch, G ; Rigaud, JP ; 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 ; 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 ; Randerath, W ; Wollborn, J ; Dindane, Z ; Kabitz, H ; Voigt, I ; Shala, G ; Faltlhauser, A ; Rovina, N ; Aidoni, Z ; Chrisanthopoulou, E ; Papadogoulas, A ; Gurjar, M ; Mahmoodpoor, A ; Ahmed, A ; Marsh, B ; Elsaka, A ; Sviri, S ; Comellini, V ; Rabha, A ; Ahmed, H ; Namendys-Silva, S ; Ghannam, A ; Groenendijk, M ; Zegers, M ; de Lange, D ; Cornet, A ; Evers, M ; Haas, L ; Dormans, T ; Dieperink, W ; Romundstad, L ; Sjøbø, B ; Andersen, F ; Strietzel, H ; Olasveengen, T ; Hahn, M ; Czuczwar, M ; Gawda, R ; Klimkiewicz, J ; Santos, ML ; Gordinho, A ; Santos, H ; Assis, R ; Oliveira, AI ; Badawy, M ; Perez-Torres, D ; Gomà, G ; Villamayor, M ; Mira, A ; Cubero, P ; Rivera, S ; Tomasa, T ; Iglesias, D ; Vázquez, E ; Aldecoa, C ; Ferreira, A ; Zalba-Etayo, B ; Canas-Perez, I ; Tamayo-Lomas, L ; Diaz-Rodriguez, C ; Sancho, S ; Priego, J ; Abualqumboz, E ; Hilles, M ; Saleh, M ; Ben-Hamouda, N ; Roberti, A ; Dullenkopf, A ; Fleury, Y ; Pinto, B ; Schefold, J ; Al-Sadaw, M
• Date: 2022
• Persistent ID: http://hdl.handle.net/10400.17/4642
• Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
• Subject(s): HSJ UCI; Humans; COVID-19* / therapy; Critical Care; Critical Illness; Intensive Care Units; Respiratory Insufficiency* / therapy; SARS-CoV-2
• Document Type: Journal article
• Language: English
• Contributor(s): Repositório da Unidade Local de Saúde São José

Description

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.