. 2022 Apr;48(4):435-447.

doi: 10.1007/s00134-022-06642-z. Epub 2022 Feb 26.

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Bertrand Guidet^{1

2}, Christian Jung³, Hans Flaatten^{4

5}, Jesper Fjølner⁶, Antonio Artigas⁷, Bernardo Bollen Pinto⁸, Joerg C Schefold⁹, Michael Beil¹⁰, Sviri Sigal¹⁰, Peter Vernon van Heerden¹¹, Wojciech Szczeklik¹², Michael Joannidis¹³, Sandra Oeyen¹⁴, Eumorfia Kondili¹⁵, Brian Marsh¹⁶, Finn H Andersen^{17

18}, Rui Moreno¹⁹, Maurizio Cecconi²⁰, Susannah Leaver²¹, Dylan W De Lange²², Ariane Boumendil^{23

24}; VIP2 and COVIP study groups

Collaborators, Affiliations

Collaborators

VIP2 and COVIP study groups:
Philipp Eller, Michael Joannidis, Dieter Mesotten, Pascal 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, Aliae A R Mohamed Hussein, Rehab Salah, Yasmin Khairy Nasr Eldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y Azzam, Ayman Abdelmawgoad Habib, Hazem Maarouf Abosheaishaa, Mohammed A Azab, Susannah Leaver, Arnaud Galbois, Tomas Urbina, Cyril Charron, Emmanuel Guerot, Guillaume Besch, Jean-Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garcon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefeve, Thierry Vanderlinden, Igor Jurcisin, Buno Megarbane, Anais Caillard, Arnaud Valent, Marc Garnier, Sebastien Besset, Johanna Oziel, Jean-Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Goncalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, Martin Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor Poerner, Hendrik Haake, Stefan Schaller, Stefan Schaller, Stefan Schaller, Detlef Kindgen-Milles, Christian Meyer, Muhammed Kurt, Karl Friedrich Kuhn, Winfried Randerath, Jakob Wollborn, Zouhir Dindane, Hans-Joachim Kabitz, Ingo Voigt, Gonxhe Shala, Andreas Faltlhauser, Nikoletta Rovina, Zoi Aidoni, Evangelia Chrisanthopoulou, Antonios Papadogoulas, Mohan Gurjar, Ata Mahmoodpoor, Abdullah Khudhur Ahmed, Brian Marsh, Ahmed Elsaka, Sigal Sviri, Vittoria Comellini, Ahmed Rabha, Hazem Ahmed, Silvio A Namendys-Silva, Abdelilah Ghannam, Martijn Groenendijk, Marieke Zegers, Dylan de Lange, Alexander Daniel Cornet, Mirjam Evers, Lenneke Haas, Tom Dormans, Willem Dieperink, Luis Romundstad, Britt Sjøbø, Finn H Andersen, Hans Frank Strietzel, Theresa Olasveengen, Michael Hahn, Miroslaw Czuczwar, Ryszard Gawda, Jakub Klimkiewicz, Maria de Lurdes Campos Santos, André Gordinho, Henrique Santos, Rui Assis, Ana Isabel Pinho Oliveira, Mohamed Raafat Badawy, David Perez-Torres, Gemma Gomà, Mercedes Ibarz Villamayor, Angela Prado Mira, Patricia Jimeno Cubero, Susana Arias Rivera, Teresa Tomasa, David Iglesias, Eric Mayor Vázquez, Cesar Aldecoa, Aida Fernández Ferreira, Begoña Zalba-Etayo, Isabel Canas-Perez, Luis Tamayo-Lomas, Cristina Diaz-Rodriguez, Susana Sancho, Jesús Priego, Enas M Y Abualqumboz, Momin Majed Yousuf Hilles, Mahmoud Saleh, Nawfel Ben-Hamouda, Andrea Roberti, Alexander Dullenkopf, Yvan Fleury, Bernardo Bollen Pinto, Joerg C Schefold, Mohammed Al-Sadaw

Affiliations

¹ UPMC 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.
² Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France. bertrand.guidet@aphp.fr.
³ Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
⁴ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁵ Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
⁶ Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
⁸ Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁹ Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland.
¹⁰ Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹¹ General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹² Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
¹³ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
¹⁴ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁵ Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece.
¹⁶ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁷ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway.
¹⁸ Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁹ Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal.
²⁰ Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy.
²¹ General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK.
²² Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands.
²³ UPMC 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.
²⁴ Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.

PMID: 35218366
PMCID: PMC8881896
DOI: 10.1007/s00134-022-06642-z

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Bertrand Guidet et al. Intensive Care Med. 2022 Apr.

. 2022 Apr;48(4):435-447.

doi: 10.1007/s00134-022-06642-z. Epub 2022 Feb 26.

Authors

Collaborators

VIP2 and COVIP study groups:
Philipp Eller, Michael Joannidis, Dieter Mesotten, Pascal 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, Aliae A R Mohamed Hussein, Rehab Salah, Yasmin Khairy Nasr Eldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y Azzam, Ayman Abdelmawgoad Habib, Hazem Maarouf Abosheaishaa, Mohammed A Azab, Susannah Leaver, Arnaud Galbois, Tomas Urbina, Cyril Charron, Emmanuel Guerot, Guillaume Besch, Jean-Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garcon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefeve, Thierry Vanderlinden, Igor Jurcisin, Buno Megarbane, Anais Caillard, Arnaud Valent, Marc Garnier, Sebastien Besset, Johanna Oziel, Jean-Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Goncalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, Martin Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor Poerner, Hendrik Haake, Stefan Schaller, Stefan Schaller, Stefan Schaller, Detlef Kindgen-Milles, Christian Meyer, Muhammed Kurt, Karl Friedrich Kuhn, Winfried Randerath, Jakob Wollborn, Zouhir Dindane, Hans-Joachim Kabitz, Ingo Voigt, Gonxhe Shala, Andreas Faltlhauser, Nikoletta Rovina, Zoi Aidoni, Evangelia Chrisanthopoulou, Antonios Papadogoulas, Mohan Gurjar, Ata Mahmoodpoor, Abdullah Khudhur Ahmed, Brian Marsh, Ahmed Elsaka, Sigal Sviri, Vittoria Comellini, Ahmed Rabha, Hazem Ahmed, Silvio A Namendys-Silva, Abdelilah Ghannam, Martijn Groenendijk, Marieke Zegers, Dylan de Lange, Alexander Daniel Cornet, Mirjam Evers, Lenneke Haas, Tom Dormans, Willem Dieperink, Luis Romundstad, Britt Sjøbø, Finn H Andersen, Hans Frank Strietzel, Theresa Olasveengen, Michael Hahn, Miroslaw Czuczwar, Ryszard Gawda, Jakub Klimkiewicz, Maria de Lurdes Campos Santos, André Gordinho, Henrique Santos, Rui Assis, Ana Isabel Pinho Oliveira, Mohamed Raafat Badawy, David Perez-Torres, Gemma Gomà, Mercedes Ibarz Villamayor, Angela Prado Mira, Patricia Jimeno Cubero, Susana Arias Rivera, Teresa Tomasa, David Iglesias, Eric Mayor Vázquez, Cesar Aldecoa, Aida Fernández Ferreira, Begoña Zalba-Etayo, Isabel Canas-Perez, Luis Tamayo-Lomas, Cristina Diaz-Rodriguez, Susana Sancho, Jesús Priego, Enas M Y Abualqumboz, Momin Majed Yousuf Hilles, Mahmoud Saleh, Nawfel Ben-Hamouda, Andrea Roberti, Alexander Dullenkopf, Yvan Fleury, Bernardo Bollen Pinto, Joerg C Schefold, Mohammed Al-Sadaw

Affiliations

¹ UPMC 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.
² Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France. bertrand.guidet@aphp.fr.
³ Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
⁴ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁵ Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
⁶ Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
⁸ Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁹ Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland.
¹⁰ Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹¹ General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹² Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
¹³ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
¹⁴ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁵ Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece.
¹⁶ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁷ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway.
¹⁸ Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁹ Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal.
²⁰ Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy.
²¹ General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK.
²² Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands.
²³ UPMC 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.
²⁴ Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.

PMID: 35218366
PMCID: PMC8881896
DOI: 10.1007/s00134-022-06642-z

Erratum in

Correction to: Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.
Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, Boumendil A; VIP2 and COVIP study groups. Guidet B, et al. Intensive Care Med. 2022 Jun;48(6):797-799. doi: 10.1007/s00134-022-06674-5. Intensive Care Med. 2022. PMID: 35357546 Free PMC article. No abstract available.

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.

Trial registration: ClinicalTrials.gov NCT03370692 NCT04321265.

Keywords: COVID; Intensive care; Mortality; Old patients; Treatment limitation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Survival curves. a Unpaired analysis. b Matched paired analysis

**Fig. 2**
Limitation of life sustaining treatments. a Unpaired analysis. b Matched paired analysis

**Fig. 3**
Survival curves in matched subgroup of patients without treatment limitation

See this image and copyright information in PMC

Comment in

ICU organization and disparities in clinical trajectories and outcomes during the pandemic.
Pitrowsky MT, Quintairos A, Salluh JIF. Pitrowsky MT, et al. Intensive Care Med. 2022 Aug;48(8):1120-1121. doi: 10.1007/s00134-022-06728-8. Epub 2022 May 9. Intensive Care Med. 2022. PMID: 35534643 Free PMC article. No abstract available.
Covid-19-ARDS hat bei über 80-Jährigen eine höhere Sterblichkeit als non-Covid-ARDS.
[No authors listed] [No authors listed] Laryngorhinootologie. 2023 Apr;102(4):253. doi: 10.1055/a-1984-2813. Epub 2023 Apr 11. Laryngorhinootologie. 2023. PMID: 37040744 German. No abstract available.

References

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Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

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Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

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Collaborators

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Conflict of interest statement

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