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

Guidet, Bertrand; Jung, Christian; Flaatten, Hans; Fjølner, Jesper; Artigas, Antonio; Pinto, Bernardo Bollen; Schefold, Joerg C; Beil, Michael; Sigal, Sviri; van Heerden, Peter Vernon; Szczeklik, Wojciech; Joannidis, Michael; Oeyen, Sandra; Kondili, Eumorfia; Marsh, Brian; Andersen, Finn H; Moreno, Rui; Cecconi, Maurizio; Leaver, Susannah; De Lange, Dylan W; ... (2022). Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19. Intensive care medicine, 48(4), pp. 435-447. Springer 10.1007/s00134-022-06642-z

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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.

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