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. 2021 May 14;11(1):77.
doi: 10.1186/s13613-021-00861-1.

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

Martin Dres  1   2 , David Hajage  3   4 , Said Lebbah  4 , Antoine Kimmoun  5   6 , Tai Pham  7   8 , Gaëtan Béduneau  9   10 , Alain Combes  11   12 , Alain Mercat  13 , Bertrand Guidet  3   14 , Alexandre Demoule  15   16 , Matthieu Schmidt  11   12 ; COVID-ICU investigators
Collaborators, Affiliations

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

Martin Dres et al. Ann Intensive Care. .

Abstract

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.

Keywords: Acute respiratory distress syndrome; COVID-19; Frailty; Intensive care unit; Intubation; Mortality; Old patients.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Day-90 mortality according to age and Clinical Frailty Scale
Fig. 2
Fig. 2
Kaplan–Meier survival estimates during the 90 days following ICU admission, according to a age (70–74 years, 75–79 years and > 80 years), b Clinical Frailty Scale (1–3; 4; >  = 5) and c PaO2/FiO2 ratio at Day-1 of ICU admission
Fig. 3
Fig. 3
Kaplan–Meier survival estimates during the 90 days following ICU admission in propensity score-matched patients
See this image and copyright information in PMC

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