Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU.
Characteristics, management, and prognosis of elderly patients with COVID 19 admitted in the ICU during the first wave_ insights from the COVID ICU study.pdf
Acute respiratory distress syndrome; COVID-19; Frailty; Intensive care unit; Intubation; Mortality; Old patients; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] BACKGROUND: The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU).
METHODS: Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality.
RESULTS: The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72-78] years). Fifty-three percent, 31%, and 16% were 70-74, 75-79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2-3). Upon admission, the PaO2/FiO2 ratio was 154 (105-222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24-2.27; p < 0·001).
CONCLUSION: Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Dres, Martin ; Médecine Intensive Réanimation (Département R3S), Service de Médecine intensive Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Site Pitié-Salpêtrière, 47-73, bd de l'Hôpital, 75651, Paris Cedex 13, France. martin.dres@aphp.fr ; UMR S 1136, Sorbonne Université INSERM UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. martin.dres@aphp.fr
Hajage, David; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France ; Unité de Recherche Clinique, AP-HP, Paris, France
Lebbah, Said; Unité de Recherche Clinique, AP-HP, Paris, France
Kimmoun, Antoine; Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Paris, France ; INSERM U1116, Vandoeuvre-les-Nancy, France
Pham, Tai; Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France ; Équipe d'Épidémiologie Respiratoire Intégrative, Center for Epidemiology and Population Health (CESP), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Villejuif, France
Béduneau, Gaëtan; Normandie Univ, UNIROUEN, EA 3830, Rouen, France ; Medical Intensive Care Unit, Rouen University Hospital, 76000, Rouen, France
Combes, Alain; Sorbonne Université, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France ; Médecine intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
Mercat, Alain; Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, CHU d'Angers, Université d'Angers, Angers, France
Guidet, Bertrand; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France ; Médecine intensive Réanimation, APHP-Sorbonne Université, Hôpital Saint Antoine, Paris, France
Demoule, Alexandre; Médecine Intensive Réanimation (Département R3S), Service de Médecine intensive Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Site Pitié-Salpêtrière, 47-73, bd de l'Hôpital, 75651, Paris Cedex 13, France ; UMR S 1136, Sorbonne Université INSERM UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
Schmidt, Matthieu; Sorbonne Université, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France ; Médecine intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
COVID-ICU investigators
Other collaborator :
Lambermont, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Language :
English
Title :
Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU.
Publication date :
14 May 2021
Journal title :
Annals of Intensive Care
eISSN :
2110-5820
Publisher :
Springer Science and Business Media Deutschland GmbH, Germany
Ministère de la Santé et de la Prévention [FR] REVA - Réseau Européen de Recherche en Ventilation Artificielle [FR] AP-HP - Assistance publique-Hôpitaux de Paris [FR]
Funding text :
This study was funded by the Foundation AP-HP and the Direction de la Recherche Clinique et du Development and the French Ministry of Health. The REVA network received a 75,000 € research grant form Air Liquide Healthcare. The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Dr Schmidt reported personal fees from Getinge, Drager, and Xenios, outside the submitted work. Dr Demoule reports personal fees from Medtronic, grants, personal fees and non-financial support from Philips, personal fees from Baxter, personal fees from Hamilton, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, personal fees from Getinge, grants and personal fees from Respinor, grants and non-financial support from Lungpacer, outside the submitted work. Dr Dres reported personal fees from Lungpacer. No other disclosures were reported.
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