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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.
Dres, Martin; Hajage, David; Lebbah, Said; Kimmoun, Antoine; Pham, Tai; Béduneau, Gaëtan; Combes, Alain; Mercat, Alain; Guidet, Bertrand; Demoule, Alexandre; Schmidt, Matthieu.
  • Dres M; Médecine Intensive Réanimation (Département R3S), Service de Médecine intensive Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Site Pitié-Salpêtrière, 47-73, bd de l'Hôpital, 75651, Paris Cedex 13, France. martin.dres@aphp.fr.
  • Hajage D; UMR S 1136, Sorbonne Université INSERM UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. martin.dres@aphp.fr.
  • Lebbah S; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
  • Kimmoun A; Unité de Recherche Clinique, AP-HP, Paris, France.
  • Pham T; Unité de Recherche Clinique, AP-HP, Paris, France.
  • Béduneau G; Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Paris, France.
  • Combes A; INSERM U1116, Vandoeuvre-les-Nancy, France.
  • Mercat A; Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France.
  • Guidet B; Équipe d'Épidémiologie Respiratoire Intégrative, Center for Epidemiology and Population Health (CESP), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Villejuif, France.
  • Demoule A; Normandie Univ, UNIROUEN, EA 3830, Rouen, France.
  • Schmidt M; Medical Intensive Care Unit, Rouen University Hospital, 76000, Rouen, France.
Ann Intensive Care ; 11(1): 77, 2021 May 14.
Article in English | MEDLINE | ID: covidwho-1229002
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

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00861-1

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00861-1