Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe
Christian Jung,
Jesper Fjølner,
Raphael Romano Bruno,
Bernhard Wernly,
Antonio Artigas,
Bernardo Bollen Pinto,
Joerg C. Schefold,
Georg Wolff,
Malte Kelm,
Michael Beil,
Sigal Sviri,
Peter Vernon van Heerden,
Wojciech Szczeklik,
Miroslaw Czuczwar,
Michael Joannidis,
Sandra Oeyen,
Tilemachos Zafeiridis,
Finn H. Andersen,
Rui Moreno,
Susannah Leaver,
Ariane Boumendil,
Dylan W. De Lange,
Bertrand Guidet,
Hans Flaatten,
, COVIP Study Group
Affiliations
Christian Jung
Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf
Jesper Fjølner
Department of Intensive Care, Aarhus University Hospital
Raphael Romano Bruno
Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf
Bernhard Wernly
Department of Cardiology, Paracelsus Medical University
Antonio Artigas
Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona
Bernardo Bollen Pinto
Department of Acute Medicine, Geneva University Hospitals
Joerg C. Schefold
Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern
Georg Wolff
Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf
Malte Kelm
Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf
Michael Beil
Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
Sigal Sviri
Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
Peter Vernon van Heerden
General Intensive Care Unit, Hadassah University Medical Center
Wojciech Szczeklik
Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College
Miroslaw Czuczwar
2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin
Michael Joannidis
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck
Sandra Oeyen
Department of Intensive Care 1K12IC, Ghent University Hospital
Tilemachos Zafeiridis
Intensive Care Unit General Hospital of Larissa
Finn H. Andersen
Department of Anaesthesia and Intensive Care, Ålesund Hospital
Rui Moreno
Unidade de Cuidados Intensivos Neurocríticos E Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School
Susannah Leaver
General Intensive Care, St George’s University Hospital NHS Foundation Trust
Ariane Boumendil
Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique
Dylan W. De Lange
Department of Intensive Care Medicine, University Medical Center, University Utrecht
Bertrand Guidet
Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique
Hans Flaatten
Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital
Abstract Background The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. Methods This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). Results In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). Conclusion An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients. Trial registration number NCT04321265 , registered March 19th, 2020.
