Mortality in older patients admitted to an ICU for COVID‐19: A systematic review

Abstract

PurposeThe objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID‐19.Materials and MethodsData sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID‐19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist.ResultsWe selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1‐month mortality from 33% to 90% and 3‐month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1‐month and 3‐month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56–4.13] and HR: 2.83 [95% CI: 1.96–4.08]).ConclusionIn this systematic review of older patients admitted to an ICU with COVID‐19, we documented high heterogeneity of mortality rates.

Frailty assessment in critically ill older adults: a narrative review

“…Patients with frailty (CFS 4–9) had a higher risk of mortality (OR = 3.12) and were less likely to be admitted to the ICU (OR 0.28) The authors then recommend that the CFS should be included in international Covid-19 treatment guidelines [ 69 ]. Another systematic review found that frailty in the ICU, assessed by the CFS, was significantly associated with 1 month and 3 month mortality respectively in two studies [ 70 ].…”