Increased mortality in ICU patients ≥70 years old with COVID-19 compared to patients with other pneumonias
Lenneke E M Haas1, Fabian Termorshuizen2,3,4, Corstiaan A den Uil5
1Department of Intensive Care Medicine, Diakonessenhuis, Utrecht, the Netherlands.
Insights
Elderly patients (≥70 years) with COVID-19 admitted to intensive care units (ICUs) have significantly higher mortality rates compared to those with bacterial or viral pneumonia. COVID-19 poses a more severe threat to this age group.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Geriatric Medicine
Background:
- Elderly patients (≥70 years) constitute a significant portion of COVID-19 ICU admissions.
- High mortality rates are observed in this demographic due to COVID-19.
Purpose of the Study:
- To compare outcomes of COVID-19 patients (≥70 years) in Dutch ICUs with similar age groups admitted for bacterial or viral pneumonia.
- To adjust for age, comorbidities, illness severity, and ICU occupancy rates in the comparison.
Main Methods:
- Retrospective cohort study of patients ≥70 years admitted to Dutch ICUs.
- Comparison between COVID-19 patients (March 2020-January 2022) and pneumonia patients (historical and current cohorts).
- Primary outcome measured was hospital mortality.
Main Results:
- 11,525 patients ≥70 years were included: 5094 with COVID-19, 5334 with bacterial pneumonia, 1312 with other viral pneumonia.
- COVID-19 patients (≥70 years) had ICU and hospital mortality rates of 39.7% and 47.6%, respectively.
- Pneumonia patients had significantly lower mortality rates (e.g., 19.5% ICU, 28.6% hospital for bacterial pneumonia historical cohort), even after adjustments.
Conclusions:
- COVID-19 is demonstrably more severe in intensive care unit (ICU) patients aged 70 and older compared to bacterial or viral pneumonia.
- The findings highlight the heightened vulnerability of the elderly to severe COVID-19 outcomes.
Background:
Patients over 70 years old represent a substantial proportion of the COVID-19 ICU population and their mortality rates are high. The aim of this study is to describe the outcomes of patients ≥70 years old admitted to Dutch ICUs with COVID-19, compared to patients ≥70 years old admitted to the ICU for bacterial and other viral pneumonias, with adjustments for age, comorbidities, severity of illness, and ICU occupancy rate.
Methods:
Retrospective cohort study including patients ≥70 years old admitted to Dutch ICUs, comparing patients admitted with COVID-19 from March 1st 2020 to January 1st 2022 with patients ≥70 years old admitted because of a bacterial and other viral pneumonia, both divided in a historical (i.e., January 1st 2017 to January 1st 2020) and current cohort (i.e., March 1st 2020 to January 1st 2022). Primary outcome is hospital mortality.
Results:
11,525 unique patients ≥70 years old admitted to Dutch ICUs were included; 5094 with COVID-19, 5334 with a bacterial pneumonia, and 1312 with another viral pneumonia. ICU-mortality and in-hospital mortality rates of the patients ≥70 years old admitted with COVID-19 were 39.7% and 47.6% respectively. ICU- and hospital mortality rates of the patients who were admitted in the same or in an historical time period with a bacterial pneumonia or other viral pneumonias were considerably lower (19.5% and 28.6% for patients with a bacterial pneumonia in the historical cohort and 19.1% and 28.8% in the same period, for the patients with other viral pneumonias 20.7% and 28.9%, and 22.7% and 31.8% respectively, all p < 0.001). Differences persisted after correction for several clinical characteristics and ICU occupancy rate.
Conclusions:
In ICU-patients ≥70 years old, COVID-19 is more severe compared to bacterial or viral pneumonia.
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