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

Bertrand Guidet, Christian Jung, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Bernardo Bollen Pinto, Joerg C Schefold, Michael Beil, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Michael Joannidis, Sandra Oeyen, Eumorfia Kondili, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Dylan W De LangeAriane Boumendil

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)435-447
JournalIntensive Care Medicine
Volume48
Issue number4
Early online date26 Feb 2022
DOIs
Publication statusPublished - Apr 2022

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