Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19

• Published in: Aging and disease Vol. 13; no. 2; pp. 614 - 623
• Main Authors: Falandry, Claire, Bitker, Laurent, Abraham, Paul, Subtil, Fabien, Collange, Vincent, Balança, Baptiste, Haïne, Max, Guichon, Céline, Leroy, Christophe, Simon, Marie, Malapert, Amélie, Pialat, Jean-Baptiste, Jallades, Laurent, Lepape, Alain, Friggeri, Arnaud, Thiolliere, Fabrice
• Format: Journal Article
• Language: English
• Published: United States JKL International 01-04-2022; Kunlin Jin; JKL International LLC
• Subjects: Aged patients; Care and treatment; Critical care medicine; Life Sciences; Original; Patient outcomes; Prognosis; France; COVID-19; geriatric parameters; intensive care; triage
• ISSN: 2152-5250; 2152-5250
• DOI: 10.14336/AD.2021.1004

The SARS-COV2 pandemic induces tensions on health systems and ethical dilemmas. Practitioners need help tools to define patients not candidate for ICU admission. A multicentre observational study was performed to evaluate the impact of age and geriatric parameters on 30-day mortality in patients aged ≥60 years of age. Patients or next of kin were asked to answer a phone questionnaire assessing geriatric covariates 1 month before ICU admission. Among 290 screened patients, 231 were included between March 7 and May 7, 2020. In univariate, factors associated with lower 30-day survival were: age (per 10 years increase; OR 3.43, [95%CI: 2.13-5.53]), ≥3 CIRS-G grade ≥2 comorbidities (OR 2.49 [95%CI: 1.36-4.56]), impaired ADL, (OR 4.86 [95%CI: 2.44-9.72]), impaired IADL8 (OR 6.33 [95%CI: 3.31-12.10], p<0.001), frailty according to the Fried score (OR 4.33 [95%CI: 2.03-9.24]) or the CFS ≥5 (OR 3.79 [95%CI: 1.76-8.15]), 6-month fall history (OR 3.46 [95%CI: 1.58-7.63]). The final multivariate model included age (per 10 years increase; 2.94 [95%CI:1.78-5.04], p<0.001) and impaired IADL8 (OR 5.69 [95%CI: 2.90-11.47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85]. Age and IADL8 provide independent prognostic factors for 30-day mortality in the considered population. Considering a risk of death exceeding 80% (82.6% [95%CI: 61.2% - 95.0%]), patients aged over 80 years with at least 1 IADL impairment appear as poor candidates for ICU admission.