Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU
| Autor: | Philippe PETUA, Xavier MONNET, Michael Levy, Marie Cantier, Nicolas WEISS, Marc Danguy des Déserts, Nicolas DUFOUR, Adrien Bouglé, Anne Godier, MICHEL CARLES, Céline Grégoire, Christophe LE TERRIER, Anne Héron, Stephane Dauger, Hafid Ait-Oufella, Matthieu Daniel, Lionel Lamhaut, Martin Dres, Anatole Harrois, Jean-Pierre QUENOT, Sebastien Preau, Guillaume Louis, Valentin Pointurier, Pierre-Henri Moury, Alexandre Mebazaa, Thibault MARTINEZ, Frank Chemouni, Benjamin Rohaut, GUILLAUME VOIRIOT, Nicolas TERZI, David Hajage, Tristan Morichau-Beauchant |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
education.field_of_study business.industry medicine.medical_treatment Hazard ratio Population 030208 emergency & critical care medicine Critical Care and Intensive Care Medicine Intensive care unit law.invention 03 medical and health sciences 0302 clinical medicine Interquartile range law Anesthesiology Cohort Emergency medicine Propensity score matching medicine Intubation 030212 general & internal medicine business education |
| Zdroj: | Annals of intensive care. 11(1) |
| ISSN: | 2110-5820 |
| Popis: | BackgroundThe COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU).MethodsCharacteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality.ResultsThe analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27;p ConclusionPatients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission. |
| Databáze: | OpenAIRE |
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