Abstract
BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.
Highlights
The first wave of the SARS-CoV-2 coronavirus disease (COVID-19) pandemic disproportionally affected the elderly population, creating an unprecedented influx of patients into hospital and intensive care [1].Jung et al Crit Care (2021) 25:149ICU capacity had to be increased several fold [2]
Many countries struggled with limited resources and were forced into a stricter admission policy to ICUs. This disproportionately affected the very old subgroup of patients, with reports of ad hoc criteria used for ICU admission, some even based on age alone
The main aim of the present study was to study the outcome of elderly patients with COVID-19 admitted to an intensive care unit and to study the influence of frailty on outcome
Summary
The first wave of the SARS-CoV-2 coronavirus disease (COVID-19) pandemic disproportionally affected the elderly population, creating an unprecedented influx of patients into hospital and intensive care [1].Jung et al Crit Care (2021) 25:149ICU capacity had to be increased several fold [2]. The first wave of the SARS-CoV-2 coronavirus disease (COVID-19) pandemic disproportionally affected the elderly population, creating an unprecedented influx of patients into hospital and intensive care [1]. Over the last few years, the assessment of frailty at admission to the ICU has become increasingly popular. The clinical frailty scale (CFS) proved to be a useful tool in predicting the chances of ICU survival in very old intensive care patients [3,4,5] and is one of a number of tools commonly used to assess frailty. 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. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients
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