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

Autor: Guidet B; UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. bertrand.guidet@aphp.fr.; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France. bertrand.guidet@aphp.fr., Jung C; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Flaatten H; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway., Fjølner J; Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark., Artigas A; Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain., Pinto BB; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland., Schefold JC; Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland., Beil M; Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Sigal S; Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., van Heerden PV; General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Szczeklik W; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland., Joannidis M; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria., Oeyen S; Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium., Kondili E; Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece., Marsh B; Mater Misericordiae University Hospital, Dublin, Ireland., Andersen FH; Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway.; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway., Moreno R; Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal., Cecconi M; Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy., Leaver S; General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK., De Lange DW; Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands., Boumendil A; UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2022 Apr; Vol. 48 (4), pp. 435-447. Date of Electronic Publication: 2022 Feb 26.
DOI: 10.1007/s00134-022-06642-z
Abstrakt: 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. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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