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Duncan CF, Lonsdale DO, Farrah H, Farnell-Ward S, Ryan C, Watson X, Cecconi M, Fjølner J, Szczeklik W, Moreno R, Artigas A, Joannidis M, De Lange DW, Guidet B, Flaatten H, Jung C, Leaver S. 30-day mortality among very old patients admitted to European intensive care units for major trauma. Gerontology 2024:000537718. [PMID: 38387455 DOI: 10.1159/000537718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Cases of major trauma in the very old (over 80 years) are increasingly common in the intensive care unit. Predicting outcome is challenging in this group of patients as chronological age is a poor marker of health and poor predictor of outcome. Increasingly, decisions are guided with the use of organ dysfunction scores of both the acute condition (e.g. Sequential Organ Failure Assessment (SOFA) score) and chronic health issues (e.g. clinical frailty scale, (CFS)). Recent work suggests that increased CFS is associated with a worse outcome in elderly major trauma patients. We aimed to test whether this association held true in the very old (over 80) or whether SOFA had a stronger association with 30-day outcome. METHODS Data from the VIP-1 and VIP-2 studies for patients over 80 years old with major trauma admissions were merged. These participants were recruited from 20 countries across Europe. Baseline characteristics, level of care provided and outcome (ICU and 30-day mortality) were summarised. Uni- and multi- variable regression analysis were undertaken to determine associations between CFS and SOFA score in the first 24-hours, type of major trauma and outcomes. RESULTS Of the 8062 acute patients recruited to the two VIP studies, 498 patients were admitted to intensive care because of major trauma. Median age was 84 years; median SOFA score was 6 (IQR 3,9) and median CFS was 3 (IQR 2,5). Survival to 30-days was 54%. Median and inter-quartile range of CFS was the same in survivors and non-survivors. In the logistic regression analysis, CFS was not associated with increased mortality. SOFA score (p<0.001) and trauma with head injury (p<0.01) were associated with increased mortality. CONCLUSIONS Major trauma admissions in the very old are not uncommon and 30-day mortality is high. We found that CFS was not a helpful predictor of mortality. SOFA and trauma with head injury were associated with worse outcomes in this patient group.
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Wernly B, Bruno RR, Beil M, Flaatten H, Kelm M, Sigal S, Szczeklik W, Elhadi M, Joannidis M, Koköfer A, Oeyen S, Marsh B, Moreno R, Wernly S, Leaver S, De Lange DW, Guidet B, Jung C. Frailty's influence on 30-day mortality in old critically ill ICU patients: a bayesian analysis evaluating the clinical frailty scale. Ann Intensive Care 2023; 13:126. [PMID: 38091131 PMCID: PMC10719192 DOI: 10.1186/s13613-023-01223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Frailty is widely acknowledged as influencing health outcomes among critically ill old patients. Yet, the traditional understanding of its impact has predominantly been through frequentist statistics. We endeavored to explore this association using Bayesian statistics aiming to provide a more nuanced understanding of this multifaceted relationship. METHODS Our analysis incorporated a cohort of 10,363 older (median age 82 years) patients from three international prospective studies, with 30-day all-cause mortality as the primary outcome. We defined frailty as Clinical Frailty Scale ≥ 5. A hierarchical Bayesian logistic regression model was employed, adjusting for covariables, using a range of priors. An international steering committee of registry members reached a consensus on a minimal clinically important difference (MCID). RESULTS In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 1.60 (95% CI 1.45-1.76). Frailty was invariably linked to adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16-1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, underscoring its clinical importance regardless of how it is measured. CONCLUSIONS This research demonstrates the significant impact of frailty on short-term mortality in critically ill elderly patients, particularly when the Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, which views frailty as a spectrum, enables more effective, personalized care for this vulnerable group. Significantly, frailty was consistently outside the region of practical equivalence (ROPE) in our analysis, highlighting its clinical importance.
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Affiliation(s)
- Bernhard Wernly
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, 5021, Bergen, Norway
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Sviri Sigal
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008, Krakow, Poland
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, 6020, Innsbruck, Austria
| | - Andreas Koköfer
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, 9000, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Rui Moreno
- Centro Hospitalar de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisboa, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Susannah Leaver
- General Intensive Care, St. George´S University Hospital NHS Foundation Trust, London, SW17 0QT, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, 3584 CX, Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Inserm, Service de'Réanimation, Sorbonne Université, Hôpital Saint-Antoine, Institut Pierre-Louis d'épidémiologie Et de Santé Publique, AP-HP, 184, Rue du Faubourg-Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany.
- Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya.
- Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Mayerhöfer T, Klein S, Wernly B, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Artigas A, van Heerden PV, Pinto BB, Schefold JC, Moreno R, Cecconi M, Szczeklik W, Jung C, Joannidis M. Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study. Infection 2023; 51:1407-1415. [PMID: 36854893 PMCID: PMC9974396 DOI: 10.1007/s15010-023-02001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. METHODS This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan-Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. RESULTS This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06-1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis. CONCLUSION Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19. STUDY REGISTRATION NCT04321265, registered March 19th, 2020.
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Affiliation(s)
- Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Assistance Publique, Hôpitaux de Paris, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, 75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- Department of Critical Care, St George's Hospital, London, UK
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Antonio Artigas
- Intensive Intensive Care Medicine Department Corporacion Sanitària Parc Tauli CIBER Enfermedades Respiratorias Institut de Investigacio e Innovació I3PT, Autonomous University of Barcelona Sabadell, Sabadell, Spain
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bernardo Bollen Pinto
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - 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), Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Polok K, Fronczek J, Guidet B, Artigas A, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Flaatten H, Jung C, Szczeklik W. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Ann Intensive Care 2023; 13:82. [PMID: 37698708 PMCID: PMC10497468 DOI: 10.1186/s13613-023-01173-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic. METHODS We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days). RESULTS The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80). CONCLUSION The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.
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Affiliation(s)
- Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Bertrand Guidet
- UMR_S 1136, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, UPMC Univ Paris 06, INSERMInstitut Pierre Louis d'Epidémiologie et de Santé PubliqueAssistance Publique - Hôpitaux de Paris, Sorbonne Universités, F-75012, Paris, France
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- Department of Critical Care, St George's Hospital, London, UK
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland.
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5
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Vallet H, Guidet B, Boumendil A, De Lange DW, Leaver S, Szczeklik W, Jung C, Sviri S, Beil M, Flaatten H. The impact of age-related syndromes on ICU process and outcomes in very old patients. Ann Intensive Care 2023; 13:68. [PMID: 37542186 PMCID: PMC10403479 DOI: 10.1186/s13613-023-01160-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 08/06/2023] Open
Abstract
In this narrative review, we describe the most important age-related "syndromes" found in the old ICU patients. The syndromes are frailty, comorbidity, cognitive decline, malnutrition, sarcopenia, loss of functional autonomy, immunosenescence and inflam-ageing. The underlying geriatric condition, together with the admission diagnosis and the acute severity contribute to the short-term, but also to the long-term prognosis. Besides mortality, functional status and quality of life are major outcome variables. The geriatric assessment is a key tool for long-term qualitative outcome, while immediate severity accounts for acute mortality. A poor functional baseline reduces the chances of a successful outcome following ICU. This review emphasises the importance of using a geriatric assessment and considering the older patient as a whole, rather than the acute illness in isolation, when making decisions regarding intensive care treatment.
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Affiliation(s)
- Hélène Vallet
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1135, Centre d'immunologie et de Maladies Infectieuses (CIMI), Department of Geriatrics, Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, F75012, Paris, France
| | - Bertrand Guidet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, service de réanimation, Sorbonne Université, INSERM, AP-HP, 75012, Paris, France.
| | - Ariane Boumendil
- service de réanimation, AP-HP, Hôpital Saint-Antoine, F75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- Department of Critical Care Medicine, St George's Hospital London, London, England
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sigal Sviri
- Department of Medical Intensive Care, Faculty of Medicine, Hebrew University and Hadassah University Medical Center, Jerusalem, Israel
| | - Michael Beil
- Department of Medical Intensive Care, Faculty of Medicine, Hebrew University and Hadassah University Medical Center, Jerusalem, Israel
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Research and Developement, Haukeland University Hospital, University of Bergen, Bergen, Norway
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6
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Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, Jung C. In reply: Sex-specific outcomes in COVID-19: missing pieces of the puzzle. Can J Anaesth 2023; 70:1110-1112. [PMID: 37165131 PMCID: PMC10171910 DOI: 10.1007/s12630-023-02470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sivri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma, Lisbon, Portugal
| | - Ariane Boumendil
- UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, Paris, France
- Assistance Publique - Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, Paris, France
- Assistance Publique - Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, Paris, France
| | - Susannah Leaver
- General Intensive Care, St George´s University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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7
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Binneboessel S, Bruno RR, Wernly B, Masyuk M, Flaatten H, Fjølner J, Wolff G, Kelm M, Beil M, Sviri S, Szczeklik W, Leaver S, De Lange DW, Guidet B, Jung C. Cytokine absorption in critically ill old COVID-19 patients with renal failure: A retrospective analysis of 503 intensive care unit patients. Clin Hemorheol Microcirc 2023; 85:105-113. [PMID: 36278342 DOI: 10.3233/ch-221579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND COVID-19 is associated with cytokine release in critical disease states. Thus, cytokine absorption has been proposed as a therapeutic option. This study investigated the influence of cytokine absorption on mortality in old critical patients with COVID-19 and renal failure admitted to intensive care units (ICU). METHODS This retrospective analysis of a prospective international observation study (the COVIP study) analysed ICU patients≥70 years with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, clinical frailty scale (CFS), ICU therapy details including renal replacement therapy (RRT) with/without cytokine absorption were collected. The cytokine absorption group was compared to patients receiving RRT without cytokine absorptionRESULTS:Among 3927 patients, 503 received RRT; among them 47 patients were treated with cytokine absorption. Mortality rates were high in both groups with increased rates in the cytokine group for ICU mortality and 30-day mortality, but not for 3-month mortality. Logistic regression analysis indicated that SOFA-score, but not cytokine absorption was associated with mortality. CONCLUSIONS Critical COVID-19 patients with renal failure treated with cytokine absorption showed higher short term mortality rates when compared to patients with renal replacement therapy alone. Mortality is associated with disease severity, but not cytokine absorption in a multivariate analysis.
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Affiliation(s)
- Stephan Binneboessel
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine, and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Maryna Masyuk
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University ofJerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University ofJerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Susannah Leaver
- General Intensive Care, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
- Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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8
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Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, Kabitz HJ, Wollborn J, Goebel U, Stoll SE, Kindgen-Milles D, Dubler S, Jung C, Fuest K, Schuster M, Papadogoulas A, Mulita F, Rovina N, Aidoni Z, CHRISANTHOPOULOU EVANGELIA, KONDILI EUMORFIA, Andrianopoulos I, Groenendijk M, Evers M, Evers M, van Lelyveld-Haas L, Meynaar I, Cornet AD, Zegers M, Dieperink W, de Lange D, Dormans T, Hahn M, Sjøbøe B, Strietzel HF, Olasveengen T, Romundstad L, Kluzik A, Zatorski P, Drygalski T, Klimkiewicz J, Solek-pastuszka J, Onichimowski D, Czuczwar M, Gawda R, Stefaniak J, Stefanska-Wronka K, Zabul E, Oliveira AIP, Assis R, de Lurdes Campos Santos M, Santos H, Cardoso FS, Gordinho A, Banzo MJA, Zalba-Etayo B, CUBERO PATRICIAJIMENO, Priego J, Gomà G, Tomasa-Irriguible TM, Sancho S, Ferreira AF, Vázquez EM, Mira ÁP, Ibarz M, Iglesias D, Arias-Rivera S, Frutos-Vivar F, Lopez-Cuenca S, Aldecoa C, Perez-Torres D, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, de Gopegui PR, Ben-Hamouda N, Roberti A, Fleury Y, Abidi N, Dullenkopf A, Pugh R, Smuts S. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial. BMC Geriatr 2022; 22:1000. [PMID: 36575394 PMCID: PMC9794407 DOI: 10.1186/s12877-022-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. METHODS This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. RESULTS 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. CONCLUSION Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19. TRIAL REGISTRATION This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
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Affiliation(s)
- Philipp Heinrich Baldia
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Department of Anaestesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Critical Care Centre, Sabadell Hospital University Institute Parc Tauli, Sabadell Barcelona, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binnebößel
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Erkens
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.5947.f0000 0001 1516 2393Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. Dep. of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Multipurpose and Neurocritical Intensive Care Unit, Hospital of São José, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W. De Lange
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Bertrand Guidet
- Institute Pierre Louis Epidemiology and Public Health, Medical Intensive Care Unit, Sorbonne University, UPMC, INSERM, Hôpital Saint-Antoine, Paris, France
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, Jung C. Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study. Can J Anaesth 2022; 69:1390-1398. [PMID: 35945477 PMCID: PMC9363137 DOI: 10.1007/s12630-022-02304-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort. METHODS We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality. RESULTS A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16). CONCLUSION In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT04321265); registered 25 March 2020).
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Affiliation(s)
- Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Philipp Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sivri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | - Susannah Leaver
- General Intensive care, St George´s University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
- Division of Cardiology, Department of Internal Medicine, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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10
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Wernly B, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Rezar R, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Wernly S, Leaver S, Boumendil A, De Lange DW, Guidet B, Perings S, Jung C. A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems. Sci Rep 2022; 12:17460. [PMID: 36261587 PMCID: PMC9580441 DOI: 10.1038/s41598-022-21580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023] Open
Abstract
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
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Affiliation(s)
- Bernhard Wernly
- grid.21604.310000 0004 0523 5263Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Anaestesia and Intensive Care, Haukeland University Hospital, 5021 Bergen, Norway
| | - Michael Beil
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jersualem, Israel
| | - Jesper Fjølner
- grid.416838.00000 0004 0646 9184Department of Anesthesia and Intensive Care, Viborg Regional Hospital, 8800 Viborg, Denmark
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Antonio Artigas
- grid.7080.f0000 0001 2296 0625Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, 08208 Sabadell, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, 3010 Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jersualem, Israel
| | - Peter Vernon van Heerden
- grid.17788.310000 0001 2221 2926Deptartment of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Richard Rezar
- grid.21604.310000 0004 0523 5263Clinic of Internal Medicine II, Department of Cardiology and Intensive Care, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, 9000 Ghent, Belgium
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, D07 R2WY Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, 6017 Ålesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Rui Moreno
- grid.418334.90000 0004 0625 3076Centro Hospitalar de Lisboa Central, Lisbon, Portugal ,grid.10772.330000000121511713Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal ,grid.7427.60000 0001 2220 7094Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal
| | - Sarah Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Susannah Leaver
- grid.264200.20000 0000 8546 682XGeneral Intensive Care, St. George´s University Hospital NHS Foundation Trust, London, SW17 0QT UK
| | - Ariane Boumendil
- grid.412370.30000 0004 1937 1100Inserm, Service de réanimation, Institut Pierre-Louis d’épidémiologie et de Santé Publique, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 184, Rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, 3584 CX Utrecht, The Netherlands
| | - Bertrand Guidet
- grid.412370.30000 0004 1937 1100Inserm, Service de réanimation, Institut Pierre-Louis d’épidémiologie et de Santé Publique, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 184, Rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Stefan Perings
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Wernly B, Rezar R, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Leaver S, Wernly S, Boumendil A, De Lange DW, Guidet B, Jung C. Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe. J Intern Med 2022; 292:438-449. [PMID: 35398948 PMCID: PMC9115222 DOI: 10.1111/joim.13492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.
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Affiliation(s)
- Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jesper Fjølner
- Department of Anesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Raphael R Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo B Pinto
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Sviri Sigal
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter V van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Brian Marsh
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, FCSaude-Universidade da Beira Interior, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St. George's University Hospital NHS Foundation Trust, London, UK
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ariane Boumendil
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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12
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Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W, Joannidis M, Mesotten D, Reper P, Oeyen S, Swinnen W, Brix H, Brushoej J, Villefrance M, Nedergaard HK, Bjerregaard AT, Balleby IR, Andersen K, Hansen MA, Uhrenholt S, Bundgaard H, Fjølner J, Hussein AARM, Salah R, Ali YKNM, Wassim K, Elgazzar YA, Tharwat S, Azzam AY, habib AA, Abosheaishaa HM, Azab MA, Leaver S, Galbois A, Guidet B, Charron C, Guerot E, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, Plantefeve G, Vanderlinden T, Jurcisin I, Megarbane B, Caillard A, Valent A, Garnier M, Besset S, Oziel J, RAPHALEN JH, Dauger S, Dumas G, Goncalves B, Piton G, Barth E, Goebel U, Barth E, Kunstein A, Schuster M, Welte M, Lutz M, Meybohm P, Steiner S, Poerner T, Haake H, Schaller S, Schaller S, Schaller S, Kindgen-Milles D, Meyer C, Kurt M, Kuhn KF, Randerath W, Wollborn J, Dindane Z, Kabitz HJ, Voigt I, Shala G, Faltlhauser A, Rovina N, Aidoni Z, Chrisanthopoulou E, Papadogoulas A, Gurjar M, Mahmoodpoor A, Ahmed AK, Marsh B, Elsaka A, Sviri S, Comellini V, Rabha A, Ahmed H, Namendys-Silva SA, Ghannam A, Groenendijk M, Zegers M, de Lange D, Cornet A, Evers M, Haas L, Dormans T, Dieperink W, Romundstad L, Sjøbø B, Andersen FH, Strietzel HF, Olasveengen T, Hahn M, Czuczwar M, Gawda R, Klimkiewicz J, de Lurdes Campos Santos M, Gordinho A, Santos H, Assis R, Oliveira AIP, Badawy MR, Perez-Torres D, Gomà G, Villamayor MI, Mira AP, Cubero PJ, Rivera SA, Tomasa T, Iglesias D, Vázquez EM, Aldecoa C, Ferreira AF, Zalba-Etayo B, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, Sancho S, Priego J, Abualqumboz EMY, Hilles MMY, Saleh M, Ben-HAmouda N, Roberti A, Dullenkopf A, Fleury Y, Bollen Pinto B, Schefold JC, Al-Sadawi M. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care 2022; 26:224. [PMID: 35869557 PMCID: PMC9305028 DOI: 10.1186/s13054-022-04082-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. METHODS This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. RESULTS Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). CONCLUSIONS Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
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Affiliation(s)
- Kamil Polok
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland ,grid.5522.00000 0001 2162 9631Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Antonio Artigas
- grid.7080.f0000 0001 2296 0625Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Hans Flaatten
- grid.412008.f0000 0000 9753 1393Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bertrand Guidet
- grid.462844.80000 0001 2308 1657INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- grid.416838.00000 0004 0646 9184Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- grid.464688.00000 0001 2300 7844Department of Critical Care Medicine, St George’s Hospital, London, UK
| | - Michael Beil
- grid.17788.310000 0001 2221 2926Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- grid.9619.70000 0004 1937 0538Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Faculdade de Ciências Médicas de Lisboa - Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal ,grid.7427.60000 0001 2220 7094Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- grid.417728.f0000 0004 1756 8807Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI Italy
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
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Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, Boumendil A. Correction to: Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19. Intensive Care Med 2022; 48:797-799. [PMID: 35357546 PMCID: PMC8968774 DOI: 10.1007/s00134-022-06674-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bertrand Guidet
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Beil
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sviri Sigal
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
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Bruno RR, Wernly B, Flaatten H, Fjølner J, Artigas A, Baldia PH, Binneboessel S, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Kondili E, Marsh B, Wollborn J, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Jung C. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19. Ann Intensive Care 2022; 12:26. [PMID: 35303201 PMCID: PMC8931579 DOI: 10.1186/s13613-022-00996-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. Results This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL < 6) the highest 3-month mortality (52 vs. 78%, p < 0.001). ADL was independently associated with 3-month mortality (ADL as a continuous variable: aHR 0.88 (95% CI 0.82–0.94, p < 0.001). Being “disable” resulted in a significant increased risk for 3-month mortality (aHR 1.53 (95% CI 1.19–1.97, p 0.001) even after adjustment for multiple confounders. Conclusion Baseline Activities of Daily Living (ADL) on admission provides additional information for outcome prediction, although most critically ill old intensive care patients suffering from COVID-19 had no restriction in their ADL prior to ICU admission. Combining frailty and disability identifies a subgroup with particularly high mortality. Trial registration number: NCT04321265. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00996-9.
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Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Paracelsusstraße 37, Oberndorf, 5110, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaestesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Philipp Heinrich Baldia
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stephan Binneboessel
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jakob Wollborn
- Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.,Universidade da Beira Interior, Covilhã, Portugal
| | - Susannah Leaver
- General Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de réanimation médicale, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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15
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Rezar R, Jung C, Mamandipoor B, Seelmaier C, Felder TK, Lichtenauer M, Wernly S, Zwaag SM, De Lange DW, Wernly B, Osmani V. Management of intoxicated patients – a descriptive outcome analysis of 4,267 ICU patients. BMC Emerg Med 2022; 22:38. [PMID: 35279068 PMCID: PMC8917674 DOI: 10.1186/s12873-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Intoxications are common in intensive care units (ICUs). The number of causative substances is large, mortality usually low. This retrospective cohort study aims to characterize differences of intoxicated compared to general ICU patients, point out variations according to causative agents, as well as to highlight differences between survivors and non-survivors among intoxicated individuals in a large-scale multi-center analysis.
Methods
A total of 105,998 general ICU patients and 4,267 individuals with the admission diagnoses “overdose” and “drug toxicity” from the years 2014 and 2015 where included from the eICU Collaborative Research Database. In addition to comparing these groups with respect to baseline characteristics, intensive care measures and outcome parameters, differences between survivors and non-survivors from the intoxication group, as well as the individual groups of causative substances were investigated.
Results
Intoxicated patients were younger (median 41 vs. 66 years; p<0.001), more often female (55 vs. 45%; p<0.001), and normal weighted (36% vs. 30%; p<0.001), whereas more obese individuals where observed in the other group (37 vs. 31%; p<0.001). Intoxicated individuals had a significantly lower mortality compared to general ICU patients (1% vs. 10%; aOR 0.07 95%CI 0.05-0.11; p<0.001), a finding which persisted after multivariable adjustment (aOR 0.17 95%CI 0.12-0.24; p<0.001) and persisted in all subgroups. Markers of disease severity (SOFA-score: 3 (1-5) vs. 4 (2-6) pts.; p<0.001) and frequency of vasopressor use (5 vs. 15%; p<0.001) where lower, whereas rates of mechanical ventilation where higher (24 vs. 26%; p<0.001) in intoxicated individuals. There were no differences with regard to renal replacement therapy in the first three days (3 vs. 4%; p=0.26). In sensitivity analysis (interactions for age, sex, ethnicity, hospital category, maximum initial lactate, mechanical ventilation, and vasopressor use), a trend towards lower mortality in intoxicated patients persisted in all subgroups.
Conclusion
This large-scale retrospective analysis indicates a significantly lower mortality of intoxicated individuals compared to general ICU patients.
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16
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Bruno RR, Wernly B, Wolff G, Fjølner J, Artigas A, Bollen Pinto B, Schefold JC, Kindgen-Milles D, Baldia PH, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Topeli A, Elhadi M, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H, Jung C. Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19. ESC Heart Fail 2022; 9:1756-1765. [PMID: 35274490 PMCID: PMC9065875 DOI: 10.1002/ehf2.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19. Methods and results Patients with pre‐existing CHF were subclassified as having ischaemic or non‐ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre‐existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5–2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5–1.5; P = 0.137]. More patients suffered from pre‐existing ischaemic than from non‐ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non‐ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9–1.0; P = 0.128). Conclusions In critically ill older COVID‐19 patients, pre‐existing CHF was not independently associated with 30 day mortality. Trial registration number: NCT04321265.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital Bern, University of Bern, Bern, Switzerland
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anaesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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 Medical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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17
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Polok K, Fronczek J, van Heerden PV, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Artigas A, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units. Br J Anaesth 2022; 128:482-490. [PMID: 34955167 PMCID: PMC8627864 DOI: 10.1016/j.bja.2021.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/20/2021] [Accepted: 11/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. METHODS This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. RESULTS The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06). CONCLUSIONS There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT04321265.
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Affiliation(s)
- Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Dylan W. De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo Bollen Pinto
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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), Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
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18
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Sikma MA, Van Maarseveen EM, Hunault CC, Moreno JM, Van de Graaf EA, Kirkels JH, Verhaar MC, Grutters JC, Kesecioglu J, De Lange DW, Huitema ADR. Correction to: Unbound Plasma, Total Plasma and Whole-Blood Tacrolimus Pharmacokinetics Early After Thoracic Organ Transplantation. Clin Pharmacokinet 2022; 61:589. [PMID: 35233710 PMCID: PMC8975789 DOI: 10.1007/s40262-022-01115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maaike A Sikma
- Dutch Poisons Information Center and Department of Intensive Care, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht and Utrecht University, F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
- Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Erik M Van Maarseveen
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Claudine C Hunault
- Dutch Poisons Information Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Javier M Moreno
- Department of Pharmacy and Pharmaceutical Technology, University of Valencia and University Hospital Dr. Peset, Valencia, Spain
| | - Ed A Van de Graaf
- Department of Lung Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Johannes H Kirkels
- Department of Heart Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jan C Grutters
- Department of Lung Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Dylan W De Lange
- Dutch Poisons Information Center and Department of Intensive Care, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht and Utrecht University, F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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19
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Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, Boumendil A. Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19. Intensive Care Med 2022; 48:435-447. [PMID: 35218366 PMCID: PMC8881896 DOI: 10.1007/s00134-022-06642-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/05/2022] [Indexed: 12/26/2022]
Abstract
Purpose The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06642-z.
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Affiliation(s)
- Bertrand Guidet
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Beil
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sviri Sigal
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Ariane Boumendil
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
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20
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Soliman IW, Leaver S, Flaatten H, Fjølner J, Wernly B, Bruno RR, Artigas A, Bollen Pinto B, Schefold JC, Beil M, Sviri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Wollborn J, Banzo MJA, Fuest K, Marsh B, Andersen FH, Moreno R, Boumendil A, Guidet B, Jung C, De Lange DW. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years. Age Ageing 2022; 51:6523677. [PMID: 35136896 PMCID: PMC8825757 DOI: 10.1093/ageing/afab278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. OBJECTIVE to quantify HRQoL in order to identify areas of interventions. DESIGN prospective observation study. SETTING admissions to European ICUs between March 2020 and February 2021. SUBJECTS patients aged 70 years or older admitted with COVID-19 disease. METHODS collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. RESULTS in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71-1.87) for CFS 2 to OR 4.33 (95% CI: 1.57-11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. CONCLUSIONS in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.
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Affiliation(s)
- Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center, University of Utrecht, Utrecht, the Netherlands
| | - Susannah Leaver
- General Intensive Care, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Raphael R Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Duesseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Jakob Wollborn
- Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Havard Medical School, Boston, MA, USA
| | - Maria Jose Arche Banzo
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Brian Marsh
- Department of Anesthesia and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, F-75012 Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, F-75012 Paris, France
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, F-75012 Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, F-75012 Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Duesseldorf, Germany
| | - Dylan W De Lange
- Address correspondence to: D. W. de Lange, Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Tel: +31 88 75 585 61; Fax: +31 88 75 556 77.
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21
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Jung C, Mamandipoor B, Fjølner J, Bruno R, Wernly B, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Czuczwar M, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, Guidet B, Flaatten H, Osmani V. Disease-course adapting machine learning prognostication models in critically ill elderly COVID-19 patients: a multi-centre cohort study with external validation. JMIR Med Inform 2021; 10:e32949. [PMID: 35099394 PMCID: PMC9015783 DOI: 10.2196/32949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background The COVID-19 pandemic caused by SARS-CoV-2 is challenging health care systems globally. The disease disproportionately affects the elderly population, both in terms of disease severity and mortality risk. Objective The aim of this study was to evaluate machine learning–based prognostication models for critically ill elderly COVID-19 patients, which dynamically incorporated multifaceted clinical information on evolution of the disease. Methods This multicenter cohort study (COVIP study) obtained patient data from 151 intensive care units (ICUs) from 26 countries. Different models based on the Sequential Organ Failure Assessment (SOFA) score, logistic regression (LR), random forest (RF), and extreme gradient boosting (XGB) were derived as baseline models that included admission variables only. We subsequently included clinical events and time-to-event as additional variables to derive the final models using the same algorithms and compared their performance with that of the baseline group. Furthermore, we derived baseline and final models on a European patient cohort, which were externally validated on a non-European cohort that included Asian, African, and US patients. Results In total, 1432 elderly (≥70 years old) COVID-19–positive patients admitted to an ICU were included for analysis. Of these, 809 (56.49%) patients survived up to 30 days after admission. The average length of stay was 21.6 (SD 18.2) days. Final models that incorporated clinical events and time-to-event information provided superior performance (area under the receiver operating characteristic curve of 0.81; 95% CI 0.804-0.811), with respect to both the baseline models that used admission variables only and conventional ICU prediction models (SOFA score, P<.001). The average precision increased from 0.65 (95% CI 0.650-0.655) to 0.77 (95% CI 0.759-0.770). Conclusions Integrating important clinical events and time-to-event information led to a superior accuracy of 30-day mortality prediction compared with models based on the admission information and conventional ICU prediction models. This study shows that machine-learning models provide additional information and may support complex decision-making in critically ill elderly COVID-19 patients. Trial Registration ClinicalTrials.gov NCT04321265; https://clinicaltrials.gov/ct2/show/NCT04321265
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Affiliation(s)
- Christian Jung
- University Hospital Duesseldorf, Moorenstraße 5, Duesseldorf, DE
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark, Aarhus, DK
| | | | - Bernhard Wernly
- Department of Anaesthesiology, Paracelsus Medical University, Salzburg, Austria, Salzburg, AT
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain, Sabadell, ES
| | - Bernardo Bollen Pinto
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland, Geneva, CH
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland, Bern, CH
| | - Georg Wolff
- University Hospital Duesseldorf, Moorenstraße 5, Duesseldorf, DE
| | - Malte Kelm
- University Hospital Duesseldorf, Moorenstraße 5, Duesseldorf, DE
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel, Jerusalem, IL
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel, Jerusalem, IL
| | - Peter Vernon van Heerden
- Dept. of Anesthesia, Intensive Care and Pain Medicine Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel, Jerusalem, IL
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland, Krakow, PL
| | - Miroslaw Czuczwar
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081, Lublin, Poland, Lublin, PL
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya, Tripoli, LY
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria, Innsbruck, AT
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium, Ghent, BE
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland;, Dublin, IE
| | - Finn H Andersen
- Dep. Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. Dep. of Circulation and medical imaging, Norwegian university of Science and Technology, Trondheim, Norway, Alesund, NO
| | - 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, Lisbon, Portugal, Lisbon, PT
| | - Maurizio Cecconi
- Department of Anaesthesia IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy, Milan, IT
| | - Susannah Leaver
- General Intensive care, St George´s University Hospitals NHS Foundation trust, London, United Kingdom, London, GB
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, the Netherlands, Utrecht, BE
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, F-75012, Paris, France. Assistance Publique - Hôpitaux de Paris, Paris, FR
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital , Bergen, Norway, Bergen, NO
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy, Trento, IT
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22
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Bruno RR, Wernly B, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, Jung C. Management and outcomes in critically ill nonagenarian versus octogenarian patients. BMC Geriatr 2021; 21:576. [PMID: 34666709 PMCID: PMC8524896 DOI: 10.1186/s12877-021-02476-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Ariane Boumendil
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.,Geriatric Research Group, Brescia, Italy
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,NTNU, Dep of Circulation and Medical Imaging, Trondheim, Norway
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBERes Corporacion Sanitaria Universitaria Parc Tauli, Barcelona, Spain
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
| | - Maurizio Cecconi
- Department of Anaesthesia, IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Johanna M Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Faculdade de Ciências Médicas de Lisboa, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Nova Médical School, Lisbon, Portugal
| | - Sandra Oeyen
- Department of Intensive Care, 1K12IC Ghent University Hospital, Ghent, Belgium
| | | | | | - Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | - Carole Boulanger
- NAHP Committee ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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23
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Jung C, Fjølner J, Bruno RR, Wernly B, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Czuczwar M, Joannidis M, Oeyen S, Zafeiridis T, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H. Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe. Crit Care 2021; 25:344. [PMID: 34556171 PMCID: PMC8459701 DOI: 10.1186/s13054-021-03739-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
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.
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Affiliation(s)
- Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Miroslaw Czuczwar
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081, Lublin, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospital NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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Sikma MA, Van Maarseveen EM, Hunault CC, Moreno JM, Van de Graaf EA, Kirkels JH, Verhaar MC, Grutters JC, Kesecioglu J, De Lange DW, Huitema ADR. Unbound Plasma, Total Plasma, and Whole-Blood Tacrolimus Pharmacokinetics Early After Thoracic Organ Transplantation. Clin Pharmacokinet 2021; 59:771-780. [PMID: 31840222 PMCID: PMC7292814 DOI: 10.1007/s40262-019-00854-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic drug monitoring of tacrolimus whole-blood concentrations is standard care in thoracic organ transplantation. Nevertheless, toxicity may appear with alleged therapeutic concentrations possibly related to variability in unbound concentrations. However, pharmacokinetic data on unbound concentrations are not available. The objective of this study was to quantify the pharmacokinetics of whole-blood, total, and unbound plasma tacrolimus in patients early after heart and lung transplantation. METHODS Twelve-hour tacrolimus whole-blood, total, and unbound plasma concentrations of 30 thoracic organ recipients were analyzed with high-performance liquid chromatography-tandem mass spectrometry directly after transplantation. Pharmacokinetic modeling was performed using non-linear mixed-effects modeling. RESULTS Plasma concentration was < 1% of the whole-blood concentration. Maximum binding capacity of erythrocytes was directly proportional to hematocrit and estimated at 2700 pg/mL (95% confidence interval 1750-3835) with a dissociation constant of 0.142 pg/mL (95% confidence interval 0.087-0.195). The inter-individual variability in the binding constants was considerable (27% maximum binding capacity, and 29% for the linear binding constant of plasma). CONCLUSIONS Tacrolimus association with erythrocytes was high and suggested a non-linear distribution at high concentrations. Monitoring hematocrit-corrected whole-blood tacrolimus concentrations might improve clinical outcomes in clinically unstable thoracic organ transplants. CLINICAL TRIAL REGISTRATION NTR 3912/EudraCT 2012-001909-24.
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Affiliation(s)
- Maaike A Sikma
- Dutch Poisons Information Center and Department of Intensive Care, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht and Utrecht University, F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. .,Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
| | - Erik M Van Maarseveen
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Claudine C Hunault
- Dutch Poisons Information Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Javier M Moreno
- Department of Pharmacy and Pharmaceutical Technology, University of Valencia and University Hospital Dr. Peset, Valencia, Spain
| | - Ed A Van de Graaf
- Department of Lung Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Johannes H Kirkels
- Department of Heart Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jan C Grutters
- Department of Lung Transplantation, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Dylan W De Lange
- Dutch Poisons Information Center and Department of Intensive Care, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht and Utrecht University, F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Department of Intensive Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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25
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Bruno RR, Wernly B, Hornemann J, Flaatten H, FjØlner J, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Baldia PH, Binneboessel S, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Kondili E, Wollborn J, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Jung C. Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients. Clin Hemorheol Microcirc 2021; 79:109-120. [PMID: 34487039 DOI: 10.3233/ch-219202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODSThe Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.RESULTSIn total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality.CONCLUSIONIn critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Johanna Hornemann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper FjØlner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Dept. of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Jakob Wollborn
- Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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26
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Bruno RR, Wernly B, Flaatten H, Fjølner J, Artigas A, Bollen Pinto B, Schefold JC, Binnebössel S, Baldia PH, Kelm M, Beil M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Wollborn J, Arche Banzo MJ, Fuest K, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Jung C. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients. Ann Intensive Care 2021; 11:128. [PMID: 34417919 PMCID: PMC8379577 DOI: 10.1186/s13613-021-00911-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. METHODS This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. RESULTS In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p < 0.001). In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1.06 95% CI 1.02-1.11; p = 0.007), 30-day mortality (aOR 1.07 95% CI 1.02-1.13; p = 0.005) and 3-month mortality (aOR 1.15 95% CI 1.08-1.24; p < 0.001) after adjustment for age, gender, SOFA score, and frailty. In 826 patients with baseline lactate ≥ 2 mmol/L sufficient data to calculate the difference between maximal levels on days 1 and 2 (∆ serum lactate) were available. A decreasing lactate concentration over time was inversely associated with ICU mortality after multivariate adjustment for SOFA score, age, Clinical Frailty Scale, and gender (aOR 0.60 95% CI 0.42-0.85; p = 0.004). CONCLUSION In critically ill old intensive care patients suffering from COVID-19, lactate and its kinetics are valuable tools for outcome prediction. TRIAL REGISTRATION NUMBER NCT04321265.
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Affiliation(s)
- Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
- grid.412008.f0000 0000 9753 1393Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- grid.7080.fDepartment of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Stephan Binnebössel
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Philipp Heinrich Baldia
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Michael Beil
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sivri Sigal
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- grid.9619.70000 0004 1937 0538General Intensive Care Unit, Deptartment of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Jakob Wollborn
- grid.38142.3c000000041936754XDepartment of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Maria José Arche Banzo
- grid.411050.10000 0004 1767 4212Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Kristina Fuest
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.10772.330000000121511713Unidade de Cuidados Intensivos Neurocríticos E Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- grid.7429.80000000121866389Institut Pierre Louis D’Epidémiologie Et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75012 Paris, France
- grid.412370.30000 0004 1937 1100Assistance Publique–Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, 75012 Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- grid.7429.80000000121866389Institut Pierre Louis D’Epidémiologie Et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75012 Paris, France
- grid.412370.30000 0004 1937 1100Assistance Publique–Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, 75012 Paris, France
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
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27
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Bruno RR, Wernly B, Mamandipoor B, Rezar R, Binnebössel S, Baldia PH, Wolff G, Kelm M, Guidet B, De Lange DW, Dankl D, Koköfer A, Danninger T, Szczeklik W, Sigal S, van Heerden PV, Beil M, Fjølner J, Leaver S, Flaatten H, Osmani V, Jung C. ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock. Front Med (Lausanne) 2021; 8:697884. [PMID: 34307423 PMCID: PMC8299710 DOI: 10.3389/fmed.2021.697884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care. Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted. Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01). Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.
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Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Richard Rezar
- Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Stephan Binnebössel
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Heinrich Baldia
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bertrand Guidet
- Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Andreas Koköfer
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Thomas Danninger
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Sviri Sigal
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | | | - Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, United Kingdom
| | - Hans Flaatten
- Department of Intensive Care, Anesthesia and Surgical Services, Haukeland University Hospital Bergen, Bergen, Norway
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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28
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Jung C, Wernly B, Fjølner J, Bruno RR, Dudzinski D, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sigal S, van Heerden PV, Szczeklik W, Czuczwar M, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H. Steroid use in elderly critically ill COVID-19 patients. Eur Respir J 2021; 58:13993003.00979-2021. [PMID: 34172464 PMCID: PMC8246007 DOI: 10.1183/13993003.00979-2021] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
More than a year after the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, treating patients with coronavirus disease 2019 (COVID-19) remains a challenge. In contrast to the rapid development of effective vaccines against SARS-CoV-2, the development of specific and effective therapeutics against COVID-19 remains largely unresolved. This secondary analysis of the COVIP study shows a higher 30-day mortality in critically ill elderly COVID-19 patients who received steroids as part of their treatment @cjungMDhttps://bit.ly/3xdyEur
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Affiliation(s)
- Christian Jung
- Medical Faculty, Dept of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- Dept of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jesper Fjølner
- Dept of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Medical Faculty, Dept of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - David Dudzinski
- Cardiac Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Antonio Artigas
- Dept of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Dept of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Medical Faculty, Dept of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Dept of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- Dept of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sviri Sigal
- Dept of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Dept of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Miroslaw Czuczwar
- 2nd Dept of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Dept of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Dept of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Dept Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Dept of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Maurizio Cecconi
- Dept of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de réanimation médicale, Paris, France
| | - Dylan W De Lange
- Dept of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de réanimation médicale, Paris, France
| | - Hans Flaatten
- Dept of Clinical Medicine, University of Bergen, Bergen, Norway.,Dept of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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Wernly B, Bruno RR, Frutos-Vivar F, Peñuelas O, Rezar R, Raymondos K, Muriel A, Du B, Thille AW, Ríos F, González M, Del-Sorbo L, Marín MDC, Pinheiro BV, Soares MA, Nin N, Maggiore SM, Bersten A, Kelm M, Amin P, Cakar N, Young Suh G, Abroug F, Jibaja M, Matamis D, Zeggwagh AA, Sutherasan Y, Guidet B, De Lange DW, Beil M, Svri S, van Heerden V, Flaatten H, Anzueto A, Osmani V, Esteban A, Jung C. Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients. Respir Care 2021; 66:814-821. [PMID: 33653910 PMCID: PMC9994107 DOI: 10.4187/respcare.08547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. METHODS In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis. RESULTS Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001). CONCLUSIONS Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. (ClinicalTrials.gov registration NCT02731898.).
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain
| | | | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Alfonso Muriel
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain
- Unidad de Bioestadística, Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias & Centro de Investigación en Red de Opidemiología y Salud Pública, Madrid, Spain
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, People's Republic of China
| | | | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Marco González
- Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lorenzo Del-Sorbo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Del Carmen Marín
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional 1 de Octubre, México City, México
| | - Bruno Valle Pinheiro
- Pulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Nicolas Nin
- Hospital Universitario de Montevideo, Montevideo, Uruguay
| | | | - Andrew Bersten
- Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Nahit Cakar
- Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gee Young Suh
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Manuel Jibaja
- Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | | | - Amine Ali Zeggwagh
- Centre Hospitalier Universitarie, Ibn Sina - Mohammed V University, Rabat, Morocco
| | - Yuda Sutherasan
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bertrand Guidet
- Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Sorbonne Universités, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Sigal Svri
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Vernon van Heerden
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Hans Flaatten
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Antonio Anzueto
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
| | - Andrés Esteban
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias, Getafe, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
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30
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Jung C, Flaatten H, Fjølner J, Bruno RR, Wernly B, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Czuczwar M, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, Boumendil A, De Lange DW, Guidet B. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study. Crit Care 2021; 25:149. [PMID: 33874987 PMCID: PMC8054503 DOI: 10.1186/s13054-021-03551-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel
| | | | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Miroslaw Czuczwar
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081, Lublin, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - 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, Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anaesthesia, IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
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Jung C, Bruno RR, Wernly B, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Fernandes AM, Artigas A, Pinto BB, Schefold J, Wolff G, Kelm M, De Lange DW, Guidet B, Flaatten H, Fjølner J. Inhibitors of the renin-angiotensin-aldosterone system and COVID-19 in critically ill elderly patients. Eur Heart J Cardiovasc Pharmacother 2021; 7:76-77. [PMID: 32645153 PMCID: PMC7454500 DOI: 10.1093/ehjcvp/pvaa083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/19/2020] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Eccles St, Northside, Dublin 7, D07 R2WY, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Åsehaugen 5, 6017 Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - 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, R. José António Serrano, 1150-199 Lisboa, Portugal
| | - Ana Margarida Fernandes
- 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, R. José António Serrano, 1150-199 Lisboa, Portugal
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Parc Taulí, 1, 08208 Sabadell, Spain
| | - Bernardo Bollen Pinto
- Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Joerg Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Bertrand Guidet
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 Rue du Faubourg Saint-Antoine, Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medecine, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
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De Groot R, Van Zoelen GA, Leenders MEC, Van Riel AJHP, De Vries I, De Lange DW. Is secondary chemical exposure of hospital personnel of clinical importance? Clin Toxicol (Phila) 2021; 59:269-278. [PMID: 33448889 DOI: 10.1080/15563650.2020.1860216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is increasing concern among hospital personnel about potential secondary exposure when treating chemically contaminated patients. OBJECTIVE To assess which circumstances and chemicals require the use of Level C Personal Protective Equipment (chemical splash suit and air-purifying respirator), to prevent secondary contamination of hospital personnel treating a chemically contaminated patient. METHODS The US National Library of Medicine PubMed database was searched for the years 1985 to 2020 utilizing combinations of relevant search terms. This yielded 557 papers which were reviewed by title and abstract. After excluding papers on biological or radiological agents, or those not related to hospital personnel, 38 papers on chemicals remained. After a full-text review, 13 papers without an in-depth discussion on the risk for secondary contamination were omitted, leaving 25 papers for review. The references of these papers were searched and this yielded another seven additional citations, bringing the total to 32 papers. INCIDENCE OF SECONDARY TOXICITY Secondary toxicity in hospital personnel is rare: a large-scale inventory of 120,000 chemical incidents identified only nine cases, an occurrence of 0.0075%. SKIN CONTACT AS A SECONDARY EXPOSURE ROUTE Skin exposure is rare under normal hygienic working conditions, reflected by the very small number of cases reported in the literature: two cases with corrosive effects due to unprotected contact and one case of presumed skin absorption. INHALATION AS A SECONDARY EXPOSURE ROUTE Most case reports described secondary toxicity as a result of inhalation. The chemicals involved were irritating solid particles (capsaicin spray/CS), toxic gases formed in the stomach of patients (arsine/hydrazoic acid/phosphine) and vapours from volatile liquids (solvents). FEATURES OF SECONDARY TOXICITY Reported symptoms after secondary inhalation were generally mild and reversible (mostly irritation of eyes and respiratory tract, nausea, headache, dizziness/light-headedness) and did not require treatment. In many cases, special circumstances increased exposure: treatment/decontamination of multiple patients, regurgitation of the chemical agent from the stomach, or inadequate room ventilation. USE OF MORE THAN STANDARD PERSONAL PROTECTIVE EQUIPMENT Normal hygienic precautions prevent direct skin contact from exposure to common chemical agents. When solid particle contamination is extensive, a mask and eye protection should be applied. Splash proof outer clothing (splash suit) and eye protection is preferred if (partial) wet decontamination is performed on single patients. Adequate ventilation, careful removal of clothing in case of solid particles contamination and adequate disposal of gastric content reduces exposure. Hospital staff can be rotated if symptoms occur, which can be odour-mediated. The use of more elaborate personal protective equipment with an air-purifying respirator (Level C) is only necessary in exceptional cases of contamination with highly toxic volatile chemicals (e.g., sarin). It should also be considered when decontaminating a large number of patients. CONCLUSIONS The risk of secondary contamination and subsequent toxicity in hospital personnel decontaminating or treating chemically contaminated patients is small. Normal hygienic precautions (gloves and water-resistant gown) will adequately protect hospital staff when treating the majority of chemically contaminated patients. More extensive protection is only necessary infrequently and there is no reason to delay critical care, even if more elaborate protection is not immediately available.
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Affiliation(s)
- Ronald De Groot
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard A Van Zoelen
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne E C Leenders
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Irma De Vries
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dylan W De Lange
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Beil M, Sviri S, Flaatten H, De Lange DW, Jung C, Szczeklik W, Leaver S, Rhodes A, Guidet B, van Heerden PV. On predictions in critical care: The individual prognostication fallacy in elderly patients. J Crit Care 2020; 61:34-38. [PMID: 33075607 PMCID: PMC7553132 DOI: 10.1016/j.jcrc.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
Predicting the future course of critical conditions involves personal experience, heuristics and statistical models. Although these methods may perform well for some cases and population averages, they suffer from substantial shortcomings when applied to individual patients. The reasons include methodological problems of statistical modeling as well as limitations of cross-sectional data sampling. Accurate predictions for individual patients become crucial when they have to guide irreversible decision-making. This notably applies to triage situations in response to a lack of healthcare resources. We will discuss these issues and argue that analysing longitudinal data obtained from time-limited trials in intensive care can provide a more robust approach to individual prognostication.
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Affiliation(s)
- Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, POB 12000, Jerusalem 9112001, Israel
| | - Sigal Sviri
- Medical Intensive Care Unit, Hadassah University Hospital, POB 12000, Jerusalem 9112001, Israel
| | - Hans Flaatten
- Intensive Care and Department of Clinical Medicine, Haukeland Universitetssjukehus, Bergen, Norway
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Christian Jung
- Division of Cardiology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wojciech Szczeklik
- Department of Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Susannah Leaver
- Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Rhodes
- Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
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Sikma MA, Hunault CC, Van Maarseveen EM, Huitema ADR, Van de Graaf EA, Kirkels JH, Verhaar MC, Grutters JC, Kesecioglu J, De Lange DW. High Variability of Whole-Blood Tacrolimus Pharmacokinetics Early After Thoracic Organ Transplantation. Eur J Drug Metab Pharmacokinet 2020; 45:123-134. [PMID: 31745812 PMCID: PMC6994432 DOI: 10.1007/s13318-019-00591-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Objective Oral tacrolimus is initiated perioperatively in heart and lung transplantation patients. There have been few studies on oral tacrolimus pharmacokinetics early post-transplantation, even though tacrolimus-related toxicity may occur early, potentially leading to morbidity and mortality. Therefore, we aimed to study the pharmacokinetics of oral tacrolimus in thoracic organ recipients during the first days after transplantation. Methods We conducted a pharmacokinetic study in 30 thoracic organ transplants at intensive care at the University Medical Center Utrecht in the first week post-transplantation. Twelve-hour whole-blood tacrolimus profiles were examined using high-performance liquid chromatography tandem mass spectrometry (HPLC–MS/MS) and analysed via population pharmacokinetic modelling. Results The concentration–time profiles showed high variability. Concentrations at 12 h were outside the target range in 69% of the cases. A two-compartment model with mixed first-order and zero-order absorption adequately described tacrolimus concentrations. The typical value of the apparent clearance was 19.6 L/h (95% CI 16.2–22.9), and the apparent distribution volumes of central and peripheral compartments, V1 and V2, were 231 L (95% CI 199–267) and 521 L (95% CI 441–634), respectively. Inter-occasion (dose-to-dose) variability far exceeded the interindividual variability (IIV), with an estimated variability in relative bioavailability of 55% (95% CI 48.5–64.4). Conclusions The high variability of tacrolimus pharmacokinetics early after thoracic organ transplantation is largely due to excessive variability in bioavailability, making individualised dosing based on measured concentrations futile. To bypass this bioavailability issue, we suggest administering tacrolimus intravenously and aiming below the upper therapeutic range early post-transplantation. Clinical Trial Registraion: NTR 3912/EudraCT 2012-001909-24. Electronic supplementary material The online version of this article (10.1007/s13318-019-00591-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maaike A Sikma
- Department of Intensive Care and Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht University, F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Claudine C Hunault
- Dutch Poisons Information Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Erik M Van Maarseveen
- Department of Clinical Pharmacy, Princess Máxima Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ed A Van de Graaf
- Department of Lung Transplantation, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Johannes H Kirkels
- Department of Cardiology, Heart Transplantation, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan C Grutters
- Department of Lung Transplantation, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,Department of Pulmonology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Dylan W De Lange
- Dutch Poisons Information Center and Department of Intensive Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Bruno RR, Wernly B, Beil M, Muessig JM, Rahmel T, Graf T, Meybohm P, Schaller SJ, Allgäuer S, Franz M, Westphal JG, Barth E, Ebelt H, Fuest K, Horacek M, Schuster M, Dubler S, Schering S, Wolff G, Steiner S, Rabe C, Dieck T, Lauten A, Sacher AL, Brenner T, Bloos F, Jánosi RA, Simon P, Utzolino S, Kelm M, De Lange DW, Guidet B, Flaatten H, Jung C. Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study. J Crit Care 2020; 60:58-63. [PMID: 32769006 DOI: 10.1016/j.jcrc.2020.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/28/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. METHODS German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. RESULTS 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82-88] vs. 83 [IQR 81-86] years p < .001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p < .0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04-1.46 p = .02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p < .001) and length of stay (144 [IQR 72-293] versus 96 [IQR 47.25-231.5] hours, p = .026). CONCLUSION In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
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Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, En Kerem, Jerusalem, Israel.
| | - Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
| | - Tobias Graf
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany.
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany; Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany.
| | | | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Julian Georg Westphal
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
| | - Eberhard Barth
- Division of Intensive Care Medicine, Department of Anesthesiology, University Hospital Ulm, Ulm, Germany.
| | - Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany.
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
| | - Michael Horacek
- Clinic of Cardiology, Alfried Krupp Hospital, Essen, Germany.
| | - Michael Schuster
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany.
| | - Simon Dubler
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Stefan Schering
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Georg Wolff
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Stephan Steiner
- Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital Limburg, Auf dem Schafsberg, 65549 Limburg, Germany.
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
| | - Thorben Dieck
- Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
| | - Alexander Lauten
- Department of Cardiology, Helios Klinikum Erfurt, Erfurt, Germany.
| | - Anne Lena Sacher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
| | - Rolf A Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany.
| | - Philipp Simon
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Stefan Utzolino
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F75012 Paris, France.
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany.
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Bruno RR, Wernly B, Guidet B, Flaatten H, De Lange DW, Jung C. Comments to "Frailty is associated with hospital readmission in geriatric patients: a prognostic study" : Assessment of frailty in geriatric patients: let's keep it simple. Eur Geriatr Med 2020; 11:885-886. [PMID: 32683575 PMCID: PMC7550375 DOI: 10.1007/s41999-020-00360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Bertrand Guidet
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, 75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, De Lange DW. Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. Intensive Care Med 2018; 44:1598-1601. [PMID: 30128586 DOI: 10.1007/s00134-018-5312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.
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Affiliation(s)
- Bertrand Guidet
- Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75013, Paris, France.
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ariane Boumendil
- Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.
| | - Alessandro Morandi
- Department of Rehabilitation, Hospital Ancelle di Cremona, Cremona, Italy.,Geriatric Research Group, Brescia, Italy
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Guido Bertolini
- Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Villa Camozzi, 24020, Ranica, Bergamo, Italy
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Åarhus, Denmark
| | | | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Åarhus, Denmark
| | - Christian Jung
- Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rui Moreno
- Unidade de Cuidados Intensivos Polivalente Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | | | - Ivo W Soliman
- Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | | | | | | | - Dylan W De Lange
- Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands
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38
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Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, De Lange DW. Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. Intensive Care Med 2018; 44:1027-1038. [DOI: 10.1007/s00134-018-5196-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/25/2018] [Indexed: 01/18/2023]
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39
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Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zaferidis T, Guidet B. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med 2017; 43:1820-1828. [DOI: 10.1007/s00134-017-4940-8] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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40
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Brinkman S, De Jonge E, Abu-Hanna A, De Lange DW, De Keizer NF. The use of linked registries to assess long-term mortality of ICU patients. Stud Health Technol Inform 2012; 180:230-234. [PMID: 22874186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Clinical registries are frequently used to monitor and analyze the quality of health care by assessing the in-hospital mortality. However, long-term mortality is often ignored as it is rarely recorded in such clinical registries. In this study linkage of a clinical registry and administrative database is used to assess the longterm mortality of a large ICU sample. Information about long-term mortality may be used to inform patients about their prognosis, to get insight in factors that influence long-term mortality, and to adjust admission policy to the ICU. This study showed that the observed mortality in the total ICU population at 3, 6, and 12 months after ICU admission was 20.3%, 22.9%, and 26.6% respectively. Medical and urgent surgery patients showed a higher long-term mortality risk and planned surgery patients showed a lower long-term mortality risk compared to the other ICU patients. In this study we have focused on the general ICU population, though linkage of clinical and administrative databases can also be used to perform analyses in specific diagnostic ICU populations or for non-ICU patients. In this study 71.4% of the clinical records could be linked with the administrative database. Future studies should focus on improving linkage of different registries.
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Affiliation(s)
- Sylvia Brinkman
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, the Netherlands.
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