Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluat...

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Published in:	Journal of clinical medicine Vol. 11; no. 6; p. 1544
Main Authors:	Andrei, Stefan, Valeanu, Liana, Stefan, Mihai Gabriel, Longrois, Dan, Popescu, Mihai, Stefan, Gabriel, Balan, Cosmin, Arafat, Raed, Corneci, Dan, Droc, Gabriela, Bubenek-Turconi, Serban-Ion, On Behalf Of The Covati-Ro Collaborative
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 11-03-2022 MDPI
Subjects:	Age Clinical medicine Coronaviruses COVID-19 Decision making Ethics Intensive care Medical prognosis Mortality Observational studies Pandemics Patients Principal components analysis Severe acute respiratory syndrome coronavirus 2 Variables Ventilators United States > US Romania COVID-19 mortality ICU mechanical ventilation outcomes elderly
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Abstract	During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.
AbstractList	Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality.BACKGROUNDDuring the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality.We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021.METHODSWe designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021.We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients.RESULTSWe included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients.In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.CONCLUSIONIn extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.
Author	Andrei, Stefan Corneci, Dan Stefan, Mihai Gabriel Popescu, Mihai Stefan, Gabriel Arafat, Raed Balan, Cosmin Valeanu, Liana Longrois, Dan Droc, Gabriela On Behalf Of The Covati-Ro Collaborative Bubenek-Turconi, Serban-Ion
AuthorAffiliation	1 Department of Anaesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; mihai.popescu@umfcd.ro (M.P.); dan.corneci@gmail.com (D.C.); gabidroc@gmail.com (G.D.); bubenek@alsys.ro (S.-I.B.-T.) 5 Anaesthesiology and Intensive Care Department III, Fundeni Clinical Institute, 258 Fundeni Road, 022328 Bucharest, Romania 4 Department of Anaesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Sorbonne Universités, INSERM UMR 1148, 46 Rue Henri Huchard, 75018 Paris, France; dan.longrois@aphp.fr 8 Anaesthesiology and Intensive Care Department I, Central Military University Emergency Hospital, 134 Plevnei Road, 010825 Bucharest, Romania 6 Nephrology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; gabriel_stefan@rocketmail.com 3 Cardiac Anaesthesiology and Intensive Care Department II, Prof. Dr. C. C. Iliescu Emergency Institute for Card
AuthorAffiliation_xml	– name: 2 Cardiac Anaesthesiology and Intensive Care Department I, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania; liana.valeanu@yahoo.com (L.V.); cosmin13mara@yahoo.com (C.B.) – name: 7 Department for Emergency Situations, Ministry of Internal Affairs, 1 Revolution Sq., 030167 Bucharest, Romania; arafatr@smurd.ro – name: 1 Department of Anaesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; mihai.popescu@umfcd.ro (M.P.); dan.corneci@gmail.com (D.C.); gabidroc@gmail.com (G.D.); bubenek@alsys.ro (S.-I.B.-T.) – name: 9 Anaesthesiology and Intensive Care Department I, Fundeni Clinical Institute, 258 Fundeni Road, 022328 Bucharest, Romania – name: 3 Cardiac Anaesthesiology and Intensive Care Department II, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni Road, 022328 Bucharest, Romania; mihaisteph@yahoo.com – name: 4 Department of Anaesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Sorbonne Universités, INSERM UMR 1148, 46 Rue Henri Huchard, 75018 Paris, France; dan.longrois@aphp.fr – name: 6 Nephrology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; gabriel_stefan@rocketmail.com – name: 8 Anaesthesiology and Intensive Care Department I, Central Military University Emergency Hospital, 134 Plevnei Road, 010825 Bucharest, Romania – name: 5 Anaesthesiology and Intensive Care Department III, Fundeni Clinical Institute, 258 Fundeni Road, 022328 Bucharest, Romania
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work. Collaborators of the COVATI-RO Collaborative is provided in the Supplementary Material.
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Snippet	During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical... Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe...
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SubjectTerms	Age Clinical medicine Coronaviruses COVID-19 Decision making Ethics Intensive care Medical prognosis Mortality Observational studies Pandemics Patients Principal components analysis Severe acute respiratory syndrome coronavirus 2 Variables Ventilators
Title	Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort
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