Differences in Mortality in Critically Ill Elderly Patients During the Second COVID-19 Surge in Europe

Abstract

The primary aim of this study was to assess the outcome of elderly ICU patients treated during the spring and autumn COVID-19 surges in Europe. MethodsA prospective European observation study (The COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020. An electronic Case Record Form was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, comorbidities, usual ICU procedures including pharmacotherapy, limitation of care, ICU length of stay and survival at 30 days. The study was registered at ClinicalTrials.gov (ID: NCT04321265). ResultsIn total 2711 patients were included, 1325 from the first and 1291 from the second surge and 94 in between. Median age was 74 and 75 years in surge 1 and surge 2 respectively. SOFA score was higher in the first surge (median 6 versus 5, p<0.0001). The PaO 2 /FiO 2 ratio at admission was higher during surge 1 and more patients received mechanical ventilation (78% versus 68%, p<0.0001). More patients were given corticosteroids in surge 2 (93 vs 38%, p<0.0001). 30 days survival was lower in the second surge (57.4% vs 49.3%) with adjusted HR of 1.43 (1.18-1.74). ConclusionAn unexpected, but significant, increase in 30-day mortality was observed during the second

The effect of age on ventilation management and clinical outcomes in critically ill COVID–19 patients––insights from the PRoVENT–COVID study

“…We found a strong association of age with mortality. This is, at least in part, in line with previous studies showing that age is a risk factor for mortality in invasively ventilated ICU patients in general [ 37 – 40 ], and in COVID–19 in particular [ 13 , 41 – 43 ]. After adjusting for comorbidities and other effect modifiers, mortality rates remained significantly higher in the older patients.…”

Comorbidities and COVID-19 Status Influence the Survival Rate of Geriatric Patients in Intensive Care Units: a Prospective Cohort Study From the Indonesian Society of Anaesthesiology and Intensive Therapy

“…6 Even in short time follow-up, the mortality rate of geriatric patients with COVID-19 in ICU is relatively high, reaching up to 80% in several studies. [23][24][25] A comparison using Indonesian Task Force big data showed that although the most common age group admitted to the hospital in the COVID-19 pandemic was 31-45 years old, the elderly population experienced the most mortality rate (>60 years old) with roughly 18%. 26 The high mortality rate in our geriatric patients is also related to pre-existing underlying diseases.…”

Caring for older adults during the COVID-19 pandemic

“…This choice was justified by ethical consideration to prioritize younger patients in a time of reduced ICU capacity. However, an interesting study by the COVIP group unexpectedly showed that elderly patients admitted to ICU during the second wave had higher short-and long-term mortality compared to the first wave [15].…”

“…A meta-analysis including more than 600.000 subjects showed that mortality changes across age categories, ranging from 9.5% (8073/ 85.358) in patients of 60-69 years old up to 29.6% (41.958/ 141.745) in those aged >80 years [14]. Table 1 and 2 summarize mortality rates extrapolated from clinical studies conducted in elderly patients with COVID-19 and factors associated with poor outcome [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Among biomarkers of infection, the increase in procalcitonin (PCT) values was associated with increased risk of hospital death in subjects > 75 years old, but not in younger ones J o u r n a l P r e -p r o o f [33].…”

“…Further studies are warranted to investigate patients' related factors and biomarkers independently associated with death in this population. The highest mortality rates (40% to 80%) are reported in elderly patients admitted to ICU [15][16]32]. Because of this finding, several intensivists were initially discouraged to admit elderly patients to ICU and used age as an exclusion criterion from ICU care [34].…”