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, Sigal Sviri, Peter Vernon van Heerden, Wojciech Szczeklik, Michael Joannidis, Sandra Oeyen, Εumorfia Kondili, Brian Marsh, Finn H. Andersen, Rui P. Moreno, Maurizio Cecconi, Susannah Leaver, Dylan W. de Lange, Ariane Boumendil, the VIP2 and COVIP study groups, Philipp Eller, Michael Joannidis, Dieter Mesotten, P. 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, Aliaë Mohamed-Hussein, Rehab Salah, Yasmin Khairy Nasr Eldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y. Azzam, Ayman Abdelmawgoad Habib, Hazem Abosheaishaa, Mohammed A. Azab, Susannah Leaver, Arnaud Galbois, Tomas Urbina, Cyril Charron, Emmanuel Guérot, Guillaume Besch, Jean‐Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garçon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefève, Thierry Vanderlinden, Igor Jurcisin, Buno Mégarbane, Anaïs Caillard, Arnaud Valent, Marc Garnier, Sébastien Besset, Johanna Oziel, Jean‐Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Gonçalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, M. Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor C. Poerner, Hendrik Haake, Stefan J. Schaller, Stefan J. Schaller, Stefan J. Schaller, Detlef Kindgen‐Milles, Christian Meyer, Muhammed Kurt, Karl Friedrich Kuhn, Winfried Randerath, Jakob Wollborn, Zouhir Dindane
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.