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Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure
Bertrand Guidet1,2, Christian Jung3, Hans Flaatten4,5
1UPMC 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.
Insights
Very old patients with COVID-19 had higher mortality and more frequent limitation of life-sustaining treatments (LLST) compared to non-COVID patients. This highlights distinct trajectories and treatment challenges in critically ill elderly individuals during the pandemic.
Area of Science:
- Critical Care Medicine
- Geriatrics
- Infectious Diseases
Background:
- The number of critically ill patients aged 80 years and older is increasing.
- Coronavirus disease 2019 (COVID-19) presents unique challenges for clinical decision-making, particularly regarding admission and limitation of life-sustaining treatments (LLST).
Purpose of the Study:
- To compare the characteristics and mortality of very old critically ill patients with and without COVID-19.
- To specifically analyze the use of LLST in these patient groups.
Main Methods:
- Patients aged 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies.
- COVID-19 and non-COVID-19 patients were matched based on age, Sequential Organ Failure Assessment (SOFA) score, clinical frailty scale, gender, and region.
- Outcomes, including 30-day survival and LLST, were compared between matched cohorts.
Main Results:
- 693 COVID-19 patients were compared to 1393 non-COVID-19 patients.
- Matched COVID-19 patients (404) compared to non-COVID-19 patients (666) showed more frequent withholding and withdrawing of life-sustaining treatments (LLST) and nearly half the 30-day survival rate.
- COVID-19 patients were younger, less frail, and less severely ill (lower SOFA score) but received invasive mechanical ventilation more often.
Conclusions:
- Very old COVID-19 patients exhibit a different clinical trajectory compared to their non-COVID-19 counterparts.
- It remains unclear whether this difference is due to more aggressive treatment limitation policies or an inherent higher risk of mortality associated with COVID-19 in this age group.
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.
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