The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study.
COVID-19
Elderly
Frailty
Outcome
Pandemia
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
19 04 2021
19 04 2021
Historique:
received:
17
02
2021
accepted:
25
03
2021
entrez:
20
4
2021
pubmed:
21
4
2021
medline:
23
4
2021
Statut:
epublish
Résumé
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
Sections du résumé
BACKGROUND
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
METHODS
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
RESULTS
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
CONCLUSION
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
Identifiants
pubmed: 33874987
doi: 10.1186/s13054-021-03551-3
pii: 10.1186/s13054-021-03551-3
pmc: PMC8054503
doi:
Banques de données
ClinicalTrials.gov
['NCT04321265']
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Subventions
Organisme : European Union's Horizon Programme
ID : H2020-INFRAEOSC-05-2018-2019
Investigateurs
Hans Flaatten
(H)
Bernhard Wernly
(B)
Antonio Artigas
(A)
Michael Beil
(M)
Sigal Sviri
(S)
Peter Vernon van Heerden
(PV)
Wojciech Szczeklik
(W)
Muhammed Elhadi
(M)
Tilemachos Zafeiridis
(T)
Rui Moreno
(R)
Maurizio Cecconi
(M)
Ariane Boumendil
(A)
Hazem Maarouf Abosheaishaa
(HM)
Enas M Y Abualqumboz
(EMY)
Abdullah Khudhur Ahmed
(AK)
Hazem Ahmed
(H)
Zoi Aidoni
(Z)
Cesar Aldecoa
(C)
Nica Alexandru
(N)
Yasmin Khairy NasrEldin Mohamed Ali
(YKNM)
Mohammed Al-Sadawi
(M)
Kasper Andersen
(K)
Finn H Andersen
(FH)
Rui Assis
(R)
Mohammed A Azab
(MA)
Ahmed Y Azzam
(AY)
Mohamed Raafat Badawy
(MR)
Ida Riise Balleby
(IR)
Eberhard Barth
(E)
Eberhard Barth
(E)
Nawfel Ben-HAmouda
(N)
Guillaume Besch
(G)
Sebastien Besset
(S)
Anders Thais Bjerregaard
(AT)
Helene Brix
(H)
Raphael Romano Bruno
(RR)
Jens Brushoej
(J)
Helle Bundgaard
(H)
Philippe Burtin
(P)
Anais Caillard
(A)
Isabel Canas-Perez
(I)
Cyril Charron
(C)
Evangelia Chrisanthopoulou
(E)
Vittoria Comellini
(V)
Alex Cornet
(A)
Patricia Jimeno Cubero
(PJ)
Miroslaw Czuczwar
(M)
Stéphane Dauger
(S)
Cristina Diaz-Rodriguez
(C)
Willem Dieperink
(W)
Zouhir Dindane
(Z)
Michel Djibré
(M)
Tom Dormans
(T)
Alexander Dullenkopf
(A)
Guillaume Dumas
(G)
Yumna A Elgazzar
(YA)
Philipp Eller
(P)
Ahmed Elsaka
(A)
Mirjam Evers
(M)
Andreas Faltlhauser
(A)
Aida Fernández Ferreira
(AF)
Jesper Fjølner
(J)
Yvan Fleury
(Y)
Arnaud Galbois
(A)
Pierre Garcon
(P)
Marc Garnier
(M)
Ryszard Gawda
(R)
Abdelilah Ghannam
(A)
Ulrich Goebel
(U)
Gemma Gomà
(G)
Bruno Goncalves
(B)
André Gordinho
(A)
Martijn Groenendijk
(M)
Emmanuel Guerot
(E)
Bertrand Guidet
(B)
Mohan Gurjar
(M)
Hendrik Haake
(H)
Lenneke Haas
(L)
Ayman Abdelmawgoad Habib
(AA)
Michael Hahn
(M)
Maria Aagaard Hansen
(MA)
Momin Majed Yousuf Hilles
(MMY)
Aliae A R Mohamed Hussein
(AARM)
David Iglesias
(D)
Michael Joannidis
(M)
Christian Jung
(C)
Igor Jurcisin
(I)
Hans-Joachim Kabitz
(HJ)
Malte Kelm
(M)
Detlef Kindgen-Milles
(D)
Jakub Klimkiewicz
(J)
Karl Friedrich Kuhn
(KF)
Anselm Kunstein
(A)
Muhammed Kurt
(M)
Dylan W De Lange
(DW)
Susannah Leaver
(S)
Matthias Lutz
(M)
Ata Mahmoodpoor
(A)
Julien Maizel
(J)
Nathalie Marin
(N)
Brian Marsh
(B)
Buno Megarbane
(B)
Dieter Mesotten
(D)
Patrick Meybohm
(P)
Christian Meyer
(C)
Angela Prado Mira
(AP)
Silvio A Namendys-Silva
(SA)
Helene Korvenius Nedergaard
(HK)
Saad Nseir
(S)
Sandra Oeyen
(S)
Theresa Olasveengen
(T)
Ana Isabel Pinho Oliveira
(AIP)
Johanna Oziel
(J)
Antonios Papadogoulas
(A)
David Perez-Torres
(D)
Bernardo Bollen Pinto
(B)
Gaël Piton
(G)
Gaëtan Plantefeve
(G)
Tudor Poerner
(T)
Jesús Priego
(J)
Ahmed Rabha
(A)
Winfried Randerath
(W)
Jean-Herlé Raphaelen
(JH)
Pascal Reper
(P)
Jean-Philippe Rigaud
(JP)
Susana Arias Rivera
(SA)
Andrea Roberti
(A)
Luis Romundstad
(L)
Nikoletta Rovina
(N)
Rehab Salah
(R)
Mahmoud Saleh
(M)
Susana Sancho
(S)
Maria de Lurdes Campos Santos
(M)
Henrique Santos
(H)
Stefan Schaller
(S)
Joerg C Schefold
(JC)
Michael Schuster
(M)
Gonxhe Shala
(G)
Britt Sjøbø
(B)
Stephan Steiner
(S)
Hans Frank Strietzel
(HF)
Sigal Sviri
(S)
Walter Swinnen
(W)
Luis Tamayo-Lomas
(L)
Samar Tharwat
(S)
Teresa Tomasa
(T)
Stine Uhrenholt
(S)
Marie Vaissiere
(M)
Arnaud Valent
(A)
Xavier Valette
(X)
Thierry Vanderlinden
(T)
Eric Mayor Vázquez
(EM)
Mercedes Ibarz Villamayor
(MI)
Maja Villefrance
(M)
Ingo Voigt
(I)
Kyrillos Wassim
(K)
Martin Welte
(M)
Georg Wolff
(G)
Jakob Wollborn
(J)
Begoña Zalba-Etayo
(B)
Marieke Zegers
(M)
Commentaires et corrections
Type : CommentIn
Références
Intensive Care Med. 2020 Jan;46(1):57-69
pubmed: 31784798
JAMA Intern Med. 2020 Jul 15;:
pubmed: 32667668
J Crit Care. 2014 Dec;29(6):896-901
pubmed: 25216948
Ann Intensive Care. 2021 Feb 3;11(1):22
pubmed: 33534010
Age Ageing. 2021 Jan 8;50(1):7-10
pubmed: 32725156
J Clin Med. 2020 Jul 04;9(7):
pubmed: 32635468
BMJ Open. 2021 Jan 17;11(1):e042140
pubmed: 33455936
Lancet Respir Med. 2020 Sep;8(9):853-862
pubmed: 32735842
Intensive Care Med. 2020 Aug;46(8):1634-1636
pubmed: 32451583
Crit Care. 2020 Jun 5;24(1):293
pubmed: 32503593
JAMA Intern Med. 2020 Oct 1;180(10):1345-1355
pubmed: 32667669
Age Ageing. 2020 Oct 23;49(6):915-922
pubmed: 32778870
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
EClinicalMedicine. 2020 Aug;25:100502
pubmed: 32835188
Aging Clin Exp Res. 2020 Sep;32(9):1897-1905
pubmed: 32705587
Intensive Care Med. 2020 May;46(5):1030-1032
pubmed: 32123988
Crit Care Med. 2015 Jul;43(7):1352-60
pubmed: 25901550
Intensive Care Med. 2017 Aug;43(8):1105-1122
pubmed: 28676896
Intensive Care Med. 2018 Jul;44(7):1027-1038
pubmed: 29774388
Intensive Care Med. 2017 Dec;43(12):1820-1828
pubmed: 28936626
Lancet Public Health. 2020 Aug;5(8):e444-e451
pubmed: 32619408
J Investig Med. 2020 Oct;68(7):1302
pubmed: 32792337
Age Ageing. 2021 Feb 26;50(2):307-316
pubmed: 32678866
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Intensive Care Med. 2020 Oct;46(10):1958-1959
pubmed: 32740666
Lancet Public Health. 2020 Nov;5(11):e580
pubmed: 33120041
J Clin Epidemiol. 2020 Jul;123:120-126
pubmed: 32330521
BMC Geriatr. 2020 Oct 16;20(1):409
pubmed: 33066750