The impact of frailty on survival in elderly intensive
care patients with COVID-19: the COVIP study
by Christian Jung, Hans Flaatten, Jesper Fjølner, Raphael
Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C.
Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sigal Sviri, Peter Vernon van
Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi…
Critical Care volume 25,
Article number: 149 (2021)
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.
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