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 Lange, Ariane Boumendil, VIP2 and COVIP study groups, Philipp Eller, Michael Joannidis, Dieter Mesotten, Pascal 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, Helle Bundgaard, Jesper Fjølner, Aliae A R Mohamed Hussein, Rehab Salah, Yasmin Khairy Nasr Eldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y Azzam, Ayman Abdelmawgoad Habib, Hazem Maarouf Abosheaishaa, Mohammed A Azab, Susannah Leaver, Arnaud Galbois, Tomas Urbina, Cyril Charron, Emmanuel Guerot, Guillaume Besch, Jean-Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garcon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefeve, Thierry Vanderlinden, Igor Jurcisin, Buno Megarbane, Anais Caillard, Arnaud Valent, Marc Garnier, Sebastien Besset, Johanna Oziel, Jean-Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Goncalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, Martin Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor Poerner, Hendrik Haake, Stefan Schaller, Stefan Schaller, Stefan 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, Nikoletta Rovina, Zoi Aidoni, Evangelia Chrisanthopoulou, Antonios Papadogoulas, Mohan Gurjar, Ata Mahmoodpoor, Abdullah Khudhur Ahmed, Brian Marsh, Ahmed Elsaka, Sigal Sviri, Vittoria Comellini, Ahmed Rabha, Hazem Ahmed, Silvio A Namendys-Silva, Abdelilah Ghannam, Martijn Groenendijk, Marieke Zegers, Dylan de Lange, Alexander Daniel Cornet, Mirjam Evers, Lenneke Haas, Tom Dormans, Willem Dieperink, Luis Romundstad, Britt Sjøbø, Finn H Andersen, Hans Frank Strietzel, Theresa Olasveengen, Michael Hahn, Miroslaw Czuczwar, Ryszard Gawda, Jakub Klimkiewicz, Maria de Lurdes Campos Santos, André Gordinho, Henrique Santos, Rui Assis, Ana Isabel Pinho Oliveira, Mohamed Raafat Badawy, David Perez-Torres, Gemma Gomà, Mercedes Ibarz Villamayor, Angela Prado Mira, Patricia Jimeno Cubero, Susana Arias Rivera, Teresa Tomasa, David Iglesias, Eric Mayor Vázquez, Cesar Aldecoa, Aida Fernández Ferreira, Begoña Zalba-Etayo, Isabel Canas-Perez, Luis Tamayo-Lomas, Cristina Diaz-Rodriguez, 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, 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 Lange, Ariane Boumendil, VIP2 and COVIP study groups, Philipp Eller, Michael Joannidis, Dieter Mesotten, Pascal 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, Helle Bundgaard, Jesper Fjølner, Aliae A R Mohamed Hussein, Rehab Salah, Yasmin Khairy Nasr Eldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y Azzam, Ayman Abdelmawgoad Habib, Hazem Maarouf Abosheaishaa, Mohammed A Azab, Susannah Leaver, Arnaud Galbois, Tomas Urbina, Cyril Charron, Emmanuel Guerot, Guillaume Besch, Jean-Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garcon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefeve, Thierry Vanderlinden, Igor Jurcisin, Buno Megarbane, Anais Caillard, Arnaud Valent, Marc Garnier, Sebastien Besset, Johanna Oziel, Jean-Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Goncalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, Martin Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor Poerner, Hendrik Haake, Stefan Schaller, Stefan Schaller, Stefan 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, Nikoletta Rovina, Zoi Aidoni, Evangelia Chrisanthopoulou, Antonios Papadogoulas, Mohan Gurjar, Ata Mahmoodpoor, Abdullah Khudhur Ahmed, Brian Marsh, Ahmed Elsaka, Sigal Sviri, Vittoria Comellini, Ahmed Rabha, Hazem Ahmed, Silvio A Namendys-Silva, Abdelilah Ghannam, Martijn Groenendijk, Marieke Zegers, Dylan de Lange, Alexander Daniel Cornet, Mirjam Evers, Lenneke Haas, Tom Dormans, Willem Dieperink, Luis Romundstad, Britt Sjøbø, Finn H Andersen, Hans Frank Strietzel, Theresa Olasveengen, Michael Hahn, Miroslaw Czuczwar, Ryszard Gawda, Jakub Klimkiewicz, Maria de Lurdes Campos Santos, André Gordinho, Henrique Santos, Rui Assis, Ana Isabel Pinho Oliveira, Mohamed Raafat Badawy, David Perez-Torres, Gemma Gomà, Mercedes Ibarz Villamayor, Angela Prado Mira, Patricia Jimeno Cubero, Susana Arias Rivera, Teresa Tomasa, David Iglesias, Eric Mayor Vázquez, Cesar Aldecoa, Aida Fernández Ferreira, Begoña Zalba-Etayo, Isabel Canas-Perez, Luis Tamayo-Lomas, Cristina Diaz-Rodriguez, 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

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.

Trial registration: ClinicalTrials.gov NCT03370692 NCT04321265.

Keywords: COVID; Intensive care; Mortality; Old patients; Treatment limitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Survival curves. a Unpaired analysis. b Matched paired analysis
Fig. 2
Fig. 2
Limitation of life sustaining treatments. a Unpaired analysis. b Matched paired analysis
Fig. 3
Fig. 3
Survival curves in matched subgroup of patients without treatment limitation

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