Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

COVIP Study Group

Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

COVIP Study Group

Heinrich Heine University Duesseldorf
Department of Intensive Care, Aarhus University Hospital
Paracelsus Medizinische Privatuniversity Salzburg
Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Sabadell and Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sagrado Corazon-General de Cataluña University Hospitals, Quiron Salud
Geneva University Hospitals
Inselspital, Bern University Hospital
Hebrew University of Jerusalem
Hadassah Medical Center
Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College
Medical University of Lublin
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck
Department of Intensive Care 1K12IC Ghent University Hospital
Intensive Care Unit General Hospital of Larissa
Department of Anaesthesia and Intensive Care, NTNU, Dep of Circulation and Medical Imaging, Ålesund Hospital
Unidade de Cuidados Intensivos Polivalente Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School
St George's University Hospital NHS Foundation Trust
Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins
Utrecht University
University of Bergen, SiB

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Abstract

BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.

METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).

RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).

CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.

TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.

Original language	English
Pages (from-to)	344
Journal	Critical Care
Volume	25
Issue number	1
Publication status	Published - 23 Sept 2021

Keywords

aged
europe
COVID-19
comorbidity
critical illness/mortality
epidemiology
female
frail elderly
humans
intensive care units
male
organ dysfunction scores
pandemics
pneumonia
prospective studies
SARS-CoV-2
survival analysis

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https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03739-7

Cite this

@article{1fc3ccf6e375483b851c2196b0f684c6,

title = "Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe",

abstract = "BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78\% versus 68\%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57\% vs 50\%) as well as after 90 days (51\% vs 40\%).CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.",

keywords = "aged, europe, COVID-19, comorbidity, critical illness/mortality, epidemiology, female, frail elderly, humans, intensive care units, male, organ dysfunction scores, pandemics, pneumonia, prospective studies, SARS-CoV-2, survival analysis, covid-19, icu, epidemiologie, kwetsbare ouderen, pandemie{\"e}n, longontsteking, sterfte, europa, vrouwelijk, mannelijk, mensen, prospectieve studies, overlevingsanalyse, comorbiditeit",

author = "\{COVIP Study Group\} and Christian Jung and Jesper Fj{\o}lner and Bruno, \{Raphael Romano\} and Bernhard Wernly and Antonio Artigas and \{Bollen Pinto\}, Bernardo and Schefold, \{Joerg C\} and Georg Wolff and Malte Kelm and Michael Beil and Sigal Sviri and \{van Heerden\}, \{Peter Vernon\} and Wojciech Szczeklik and Miroslaw Czuczwar and Michael Joannidis and Sandra Oeyen and Tilemachos Zafeiridis and Andersen, \{Finn H\} and Rui Moreno and Susannah Leaver and Ariane Boumendil and \{De Lange\}, \{Dylan W\} and Bertrand Guidet and Hans Flaatten and Willem Dieperink",

note = "{\textcopyright} 2021. The Author(s).",

year = "2021",

month = sep,

day = "23",

language = "English",

volume = "25",

pages = "344",

journal = "Critical Care",

issn = "1364-8535",

publisher = "Springer Nature-BioMed Central",

number = "1",

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TY - JOUR

T1 - Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

AU - COVIP Study Group

AU - Jung, Christian

AU - Fjølner, Jesper

AU - Bruno, Raphael Romano

AU - Wernly, Bernhard

AU - Artigas, Antonio

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 - Joannidis, Michael

AU - Oeyen, Sandra

AU - Zafeiridis, Tilemachos

AU - Andersen, Finn H

AU - Moreno, Rui

AU - Leaver, Susannah

AU - Boumendil, Ariane

AU - De Lange, Dylan W

AU - Guidet, Bertrand

AU - Flaatten, Hans

AU - Dieperink, Willem

PY - 2021/9/23

Y1 - 2021/9/23

N2 - BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.

AB - BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.

KW - aged

KW - europe

KW - COVID-19

KW - comorbidity

KW - critical illness/mortality

KW - epidemiology

KW - female

KW - frail elderly

KW - humans

KW - intensive care units

KW - male

KW - organ dysfunction scores

KW - pandemics

KW - pneumonia

KW - prospective studies

KW - SARS-CoV-2

KW - survival analysis

KW - covid-19

KW - icu

KW - epidemiologie

KW - kwetsbare ouderen

KW - pandemieën

KW - longontsteking

KW - sterfte

KW - europa

KW - vrouwelijk

KW - mannelijk

KW - mensen

KW - prospectieve studies

KW - overlevingsanalyse

KW - comorbiditeit

M3 - Article

C2 - 34556171

SN - 1364-8535

VL - 25

SP - 344

JO - Critical Care

JF - Critical Care

IS - 1

ER -

Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

Abstract

Keywords

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