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A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems.
Wernly, Bernhard; Flaatten, Hans; Beil, Michael; Fjølner, Jesper; Bruno, Raphael Romano; Artigas, Antonio; Pinto, Bernardo Bollen; Schefold, Joerg C; Kelm, Malte; Sigal, Sviri; van Heerden, Peter Vernon; Szczeklik, Wojciech; Elhadi, Muhammed; Joannidis, Michael; Rezar, Richard; Oeyen, Sandra; Wolff, Georg; Marsh, Brian; Andersen, Finn H; Moreno, Rui; Wernly, Sarah; Leaver, Susannah; Boumendil, Ariane; De Lange, Dylan W; Guidet, Bertrand; Perings, Stefan; Jung, Christian.
  • Wernly B; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.
  • Flaatten H; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria.
  • Beil M; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • Fjølner J; Department of Anaestesia and Intensive Care, Haukeland University Hospital, 5021, Bergen, Norway.
  • Bruno RR; Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120, Jersualem, Israel.
  • Artigas A; Department of Anesthesia and Intensive Care, Viborg Regional Hospital, 8800, Viborg, Denmark.
  • Pinto BB; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
  • Schefold JC; Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, 08208, Sabadell, Spain.
  • Kelm M; Department of Acute Medicine, Geneva University Hospitals, 1205, Geneva, Switzerland.
  • Sigal S; Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, 3010, Bern, Switzerland.
  • van Heerden PV; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
  • Szczeklik W; Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120, Jersualem, Israel.
  • Elhadi M; Deptartment of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120, Jerusalem, Israel.
  • Joannidis M; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008, Krakow, Poland.
  • Rezar R; Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya.
  • Oeyen S; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, 6020, Innsbruck, Austria.
  • Wolff G; Clinic of Internal Medicine II, Department of Cardiology and Intensive Care, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria.
  • Marsh B; Department of Intensive Care 1K12IC, Ghent University Hospital, 9000, Ghent, Belgium.
  • Andersen FH; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
  • Moreno R; Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland.
  • Wernly S; Department of Anaesthesia and Intensive Care, Ålesund Hospital, 6017, Ålesund, Norway.
  • Leaver S; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
  • Boumendil A; Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
  • De Lange DW; Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal.
  • Guidet B; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal.
  • Perings S; Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria.
  • Jung C; General Intensive Care, St. George´s University Hospital NHS Foundation Trust, London, SW17 0QT, UK.
Sci Rep ; 12(1): 17460, 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2077101
ABSTRACT
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Sci Rep Year: 2022 Document Type: Article Affiliation country: S41598-022-21580-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Sci Rep Year: 2022 Document Type: Article Affiliation country: S41598-022-21580-y