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Article Dans Une Revue Annals of Intensive Care Année : 2021

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

Martin Dres
David Hajage
  • Fonction : Auteur
Said Lebbah
  • Fonction : Auteur
Antoine Kimmoun
  • Fonction : Auteur
Tai Pham
Gaëtan Béduneau
  • Fonction : Auteur
Alain Combes
  • Fonction : Auteur
Alain Mercat
  • Fonction : Auteur
Bertrand Guidet
  • Fonction : Auteur
Alexandre Demoule
  • Fonction : Auteur
Matthieu Schmidt
  • Fonction : Auteur

Résumé

Abstract Background The 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). Methods Characteristics, 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. Results The 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 PaO 2 /FiO 2 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 PaO 2 /FiO 2 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). Conclusion Patients 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.

Dates et versions

hal-04418503 , version 1 (26-01-2024)

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Martin Dres, David Hajage, Said Lebbah, Antoine Kimmoun, Tai Pham, et al.. 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, 2021, 11 (1), pp.77. ⟨10.1186/s13613-021-00861-1⟩. ⟨hal-04418503⟩
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