Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

Annals of Intensive Care

Alain Mercat¹  Alexandre Demoule²  Martin Dres²  Gaëtan Béduneau³  Antoine Kimmoun⁴  Tai Pham⁵  Bertrand Guidet⁶  David Hajage⁷  Alain Combes⁸  Matthieu Schmidt⁸  Said Lebbah⁹ 

[1] Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, CHU d’Angers, Université d’Angers, Angers, France;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;UMR S 1136, Sorbonne Université INSERM UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France;Normandie Univ, UNIROUEN, EA 3830, Rouen, France;Medical Intensive Care Unit, Rouen University Hospital, 76000, Rouen, France;Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Paris, France;INSERM U1116, Vandoeuvre-les-Nancy, France;Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France;Équipe d’Épidémiologie Respiratoire Intégrative, Center for Epidemiology and Population Health (CESP), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Villejuif, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France;Médecine intensive Réanimation, APHP-Sorbonne Université, Hôpital Saint Antoine, Paris, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France;Unité de Recherche Clinique, AP-HP, Paris, France;Sorbonne Université, INSERM, UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France;Médecine intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France;Unité de Recherche Clinique, AP-HP, Paris, France;

关键词: Acute respiratory distress syndrome;    Intubation;    COVID-19;    Mortality;    Old patients;    Intensive care unit;    Frailty;   

DOI  :  10.1186/s13613-021-00861-1

来源: Springer

【 摘 要 】

BackgroundThe 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).MethodsCharacteristics, 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.ResultsThe 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).ConclusionPatients 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.

【 授权许可】

CC BY