TY - JOUR
T1 - The impact of frailty on survival in elderly intensive care patients with COVID-19 :
T2 - the COVIP study
AU - Jung, Christian
AU - Flaatten, Hans
AU - Fjølner, Jesper
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Artigas Raventós, Antoni
AU - Bollen Pinto, Bernardo
AU - Schefold, Joerg C.
AU - Wolff, Georg
AU - Kelm, Malte
AU - Beil, Michael
AU - Sviri, Sigal
AU - van Heerden, Peter Vernon
AU - Szczeklik, Wojciech
AU - Czuczwar, Miroslaw
AU - Elhadi, Muhammed
AU - Joannidis, Michael
AU - Oeyen, Sandra
AU - Zafeiridis, Tilemachos
AU - Marsh, Brian
AU - Andersen, Finn H.
AU - Moreno, Rui
AU - Cecconi, Maurizio
AU - Leaver, Susannah
AU - Boumendil, Ariane
AU - De Lange, Dylan W..
AU - Guidet, Bertrand
PY - 2021
Y1 - 2021
N2 - The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: , registered 19 March 2020. The online version contains supplementary material available at 10.1186/s13054-021-03551-3.
AB - The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: , registered 19 March 2020. The online version contains supplementary material available at 10.1186/s13054-021-03551-3.
KW - COVID-19
KW - Frailty
KW - Outcome
KW - Elderly
KW - Pandemia
U2 - 10.1186/s13054-021-03551-3
DO - 10.1186/s13054-021-03551-3
M3 - Article
C2 - 33874987
SN - 1466-609X
VL - 25
JO - Critical Care
JF - Critical Care
ER -