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1. Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Author

Guidet, B., Jung, C., Flaatten, H., Fjølner, J., Artigas, A., Pinto, B.B., Schefold, J.C., Beil, M., Sigal, S., Heerden, P.V. van, Szczeklik, W., Joannidis, M., Oeyen, S., Kondili, E., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Leaver, S., Zegers, M., Lange, D.W. de, Boumendil, A., and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Critical Care, SARS-CoV-2, Critical Illness, COVID-19, Treatment limitation, Critical Care and Intensive Care Medicine, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Intensive Care Units, Respiratory Insufficiency/therapy, Intensive care, Old patients, Humans, Mortality, Respiratory Insufficiency, 610 Medicine & health, COVID-19/therapy, COVID
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.

Published
2022
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2. Caractéristiques des traitements en fonction du sexe et résultats de mortalité à 30 jours des patients atteints de COVID-19 gravement malades de plus de 70 ans—résultats de l’étude prospective COVIP

Author

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, Sandra, Flamm, M, Zafeiridis, T, Marsh, B, Andersen, FH, Moreno, R, Boumendil, A, De Lange, DW, Guidet, B, Leaver, S, Jung, C, COVIP Study, Group, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Subjects
Male, Aged, 80 and over, Frailty, Critical Illness, COVID-19, 610 Medicine & health, General Medicine, COVIP, mortality, elderly, Intensive Care Units, Anesthesiology and Pain Medicine, Medicine and Health Sciences, Humans, sex, critical illness, Female, Prospective Studies, 610 Medizin und Gesundheit, Pandemics, Aged, COVID
Abstract

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.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.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%; P0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P0.001). 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).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.www.gov (NCT04321265); registered 25 March 2020).RéSUMé: OBJECTIF: Les patients âgés gravement malades atteints de la COVID-19 ont été les plus vulnérables pendant la pandémie actuelle, les hommes étant plus sujets à l’hospitalisation et aux maladies graves que les femmes. Nous avons cherché à explorer les différences spécifiques au sexe dans le traitement et les devenirs après l’admission à l’unité de soins intensifs (USI) dans cette cohorte. MéTHODE: Nous avons effectué une analyse spécifique au sexe chez des patients gravement malades âgés de ≥ 70 ans atteints de COVID-19 qui ont été inclus dans l’étude prospective multicentrique internationale COVIP. Tous les patients ont été analysés pour connaître les détails de leur admission à l’USI et les caractéristiques de leur traitement. Nous avons réalisé une analyse de régression ajustée à plusieurs niveaux pour élucider les associations entre le sexe et la mortalité à 30 jours. RéSULTATS: Au total, 3159 patients (69,8 % d’hommes, 30,2 % de femmes; âge médian, 75 ans) ont été inclus. Les patients de sexe masculin étaient significativement plus en forme que les patientes, tel que déterminé par l’échelle de fragilité clinique (bonne santé, 67 % vs 54 %; vulnérables, 14 % vs 19 %; fragiles, 19 % vs 27 %; P0,001). Les patients de sexe masculin ont plus souvent bénéficié d’une trachéostomie (20 % vs 14 %; rapport de cotes [RC], 1,57; P0,001), d’un traitement vasopresseur (69 % vs 62 %; RC, 1,25; P = 0,02) et d’un traitement substitutif de l’insuffisance rénale (17 % vs 11 %; RC, 1,96; P0,001). Il n’y avait aucune différence en matière de ventilation mécanique, de limites des traitements de maintien en vie et de mortalité brute à 30 jours (50 % d’hommes vs 49 % de femmes; RC, 1,11; P = 0,19), ce qui est demeuré le cas après ajustement pour tenir compte de la gravité de la maladie, de la fragilité, de l’âge et des limites du traitement (RC, 1,17 ; intervalle de confiance à 95 %, 0,94 à 1,45; P = 0,16). CONCLUSION: Dans cette analyse des caractéristiques de traitement spécifiques au sexe et des résultats de mortalité à 30 jours des patients gravement malades atteints de COVID-19 de ≥ 70 ans, nous avons noté un nombre plus élevé de trachéotomies et de traitements substitutifs de l’insuffisance rénale chez les hommes vs les femmes, mais aucune association significative entre le sexe des patients et la mortalité à 30 jours. ENREGISTREMENT DE L’éTUDE: www.ClinicalTrials.gov (NCT04321265); enregistré le 25 mars 2020.

Published
2022
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5. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Author

Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Baldia, P.H., Binneboessel, S., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Kondili, E., Marsh, B., Wollborn, J., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., Jung, C., Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Baldia, P.H., Binneboessel, S., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Kondili, E., Marsh, B., Wollborn, J., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., and Jung, C.

Abstract

Contains fulltext : 282926.pdf (Publisher’s version ) (Open Access), 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.

Published
2022

6. 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

Author

Soliman, I.W., Leaver, S., Flaatten, H., Fjølner, J., Wernly, B., Bruno, R.R., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Boumendil, A., Guidet, B., Zegers, M., Jung, C., Lange, D.W. de, Soliman, I.W., Leaver, S., Flaatten, H., Fjølner, J., Wernly, B., Bruno, R.R., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Boumendil, A., Guidet, B., Zegers, M., Jung, C., and Lange, D.W. de

Abstract

Contains fulltext : 252215.pdf (Publisher’s version ) (Open Access), 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.

Published
2022

7. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

Author

Polok, K., Fronczek, J., Artigas, A., Flaatten, H., Guidet, B., Lange, D.W. de, Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R.R., Wernly, B., Pinto, B. Bollen, Schefold, J.C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Zegers, M., Jung, C., Szczeklik, W., Polok, K., Fronczek, J., Artigas, A., Flaatten, H., Guidet, B., Lange, D.W. de, Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R.R., Wernly, B., Pinto, B. Bollen, Schefold, J.C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Zegers, M., Jung, C., and Szczeklik, W.

Abstract

Contains fulltext : 283094.pdf (Publisher’s version ) (Open Access), 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 .

Published
2022

8. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial

Author

Baldia, P.H., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Pinto, B.B., Schefold, J.C., Kelm, M., Beil, M., Bruno, R.R., Binnebößel, S., Wolff, G., Erkens, R., Sigal, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Leaver, S., Lange, D.W. de, Zegers, M., Guidet, B., Jung, C., Baldia, P.H., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Pinto, B.B., Schefold, J.C., Kelm, M., Beil, M., Bruno, R.R., Binnebößel, S., Wolff, G., Erkens, R., Sigal, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Leaver, S., Lange, D.W. de, Zegers, M., Guidet, B., and Jung, C.

Abstract

Contains fulltext : 287644.pdf (Publisher’s version ) (Open Access), 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: Parace

Published
2022

9. a prospective cohort study

Author

Fronczek, Jakub, Polok, Kamil, de Lange, Dylan W., Jung, Christian, Beil, Michael, Rhodes, Andrew, Fjølner, J., Górka, Jacek, Andersen, Finn H., Artigas, Antonio, Cecconi, Maurizio, Christensen, Steffen, Joannidis, Michael, Leaver, Susannah, Marsh, Brian, Morandi, Alessandro, Moreno, Rui, Oeyen, S., Agvald-Öhman, Christina, Bollen Pinto, B., Schefold, J. C., Valentin, Andreas, Walther, Sten, Watson, Ximena, Zafeiridis, Tilemachos, Sviri, Sigal, van Heerden, Peter Vernon, Flaatten, Hans, Guidet, Bertrand, Szczeklik, Wojciech, Schmutz, R., Wimmer, F., Eller, P., Joannidis, M., De Buysscher, P., De Neve, N., Swinnen, W., Abraham, P., Hergafi, L., Biskup, E., Piza, P., Taliadoros, I., Dey, N., Sølling, C., Rasmussen, B. S., Ferreira, I. A., and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Subjects
Intensive care units, Frailty, Aged, 80 and over, Mortality, Critical Care and Intensive Care Medicine, Prospective studies
Abstract

Funding Information: The members of VIP1 and VIP2 study groups are listed in Additional file 1 and are listed in their individual PubMed records. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved. Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion: Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2) publishersversion published

Published
2021

10. Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Author

Fronczek, Jakub, Polok, Kamil, de Lange, Dylan W., Jung, Christian, Beil, Michael, Rhodes, Andrew, Fjølner, Jesper, Górka, Jacek, Andersen, Finn H., Artigas, Antonio, Cecconi, Maurizio, Christensen, Steffen, Joannidis, Michael, Leaver, Susannah, Marsh, Brian, Morandi, Alessandro, Moreno, Rui, Oeyen, Sandra, Agvald-Öhman, Christina, Bollen Pinto, Bernardo, Schefold, Joerg C., Valentin, Andreas, Walther, Sten, Watson, Ximena, Zafeiridis, Tilemachos, Sviri, Sigal, van Heerden, Peter Vernon, Flaatten, Hans, Guidet, Bertrand, Szczeklik, Wojciech, Schmutz, R., Wimmer, F., Eller, P., Joannidis, M., De Buysscher, P., De Neve, N., Oeyen, S., Swinnen, W., Bollen Pinto, B., Abraham, P., Hergafi, L., Schefold, J. C., Biskup, E., Piza, P., Taliadoros, I., Fjølner, J., Dey, N., Sølling, C., Rasmussen, B. S., Christensen, S., Forceville, X., Besch, G., Mentec, H., Michel, P., Mateu, P., Vettoretti, L., Bourenne, J., Marin, N., Guillot, M., Aissaoui, N., Goulenok, C., Thieulot-Rolin, N., Messika, J., Lamhaut, L., Guidet, B., Charron, C., Lauten, A., Sacher, A. L., Brenner, T., Franz, M., Bloos, F., Ebelt, H., Schaller, S. J., Fuest, K., Rabe, C., Dieck, T., Steiner, S., Graf, T., Nia, A. M., Jung, C., Janosi, R. A., Meybohm, P., Simon, P., Utzolino, S., Rahmel, T., Barth, E., Schuster, M., Aidoni, Z., Aloizos, S., Tasioudis, P., Lampiri, K., Zisopoulou, V., Ravani, I., Pagaki, E., Antoniou, A., Katsoulas, T. A., Kounougeri, A., Marinakis, G., Tsimpoukas, F., Spyropoulou, A., Zygoulis, P., Kyparissi, A., Gupta, M., Gurjar, M., Maji, I. M., Hayes, I., Marsh, B., Kelly, Y., Westbrook, A., Fitzpatrick, G., Maheshwari, D., Motherway, C., Negri, G., Spadaro, S., Nattino, G., Pedeferri, M., Boscolo, A., Rossi, S., Calicchio, G., Cubattoli, L., Di Lascio, G., Barbagallo, M., Berruto, F., Codazzi, D., Bottazzi, A., Fumagalli, P., Negro, G., Lupi, G., Savelli, F., Vulcano, G. A., Fumagalli, R., Marudi, A., Lefons, U., Lembo, R., Babini, M., Paggioro, A., Parrini, V., Zaccaria, M., Clementi, S., Gigliuto, C., Facondini, F., Pastorini, S., Munaron, S., Calamai, I., Bocchi, A., Adorni, A., Bocci, M. G., Cortegiani, A., Casalicchio, T., Mellea, S., Graziani, E., Barattini, M., Brizio, E., Rossi, M., Hahn, M., Flaatten, H., Kemmerer, N., Strietzel, H. F., Dybwik, K., Legernaes, T., Klepstad, P., Olaussen, E. B., Olsen, K. I., Brresen, O. M., Bjorsvik, G., Andersen, F. H., Maini, S., Fehrle, L., Czuczwar, M., Krawczyk, P., Ziętkiewicz, M., Nowak, Ł. R., Kotfis, K., Cwyl, K., Gajdosz, R., Biernawska, J., Bohatyrewicz, R., Gawda, R., Grudzień, P., Nasiłowski, P., Popek, N., Cyrankiewicz, W., Wawrzyniak, K., Wnuk, M., Maciejewski, D., Studzińska, D., Żukowski, M., Bernas, S., Piechota, M., Szczeklik, W., Nowak-Kózka, I., Fronczek, J., Serwa, M., Machała, W., Stefaniak, J., Wujtewicz, M., Maciejewski, P., Szymkowiak, M., Adamik, B., Polok, K., Górka, J., Catorze, N., Branco, M. C., Barros, N., Barros, I., Krystopchuk, A., Honrado, T., Sousa, C., Munoz, F., Rebelo, M., Gomes, R., Nunes, J., Dias, C., Fernandes, A. M., Petrisor, C., Constantin, B., Belskiy, V., Boskholov, B., Rodriguez, E., Aguilar, G., Masdeu, G., Jaimes, M. I., Mira, A. P., Bodi, M. A., Mendoza, J. A. B., López-Cuenca, S., Guzman, M. H., Rico-Feijoo, J., Ibarz, M., Alvarez, J. Trenado, Kawati, R., Sivik, J., Nauska, J., Smole, D., Parenmark, F., Lyrén, J., Rockstroh, K., Rydén, S., Spångfors, M., Strinnholm, M., Walther, S., De Geer, L., Nordlund, P., Pålsson, S., Zetterquist, H., Nilsson, A., Thiringer, K., Jungner, M., Bark, B., Nordling, B., Sköld, H., Brorsson, C., Persson, S., Bergström, A., Berkius, J., Holmström, J., van Dijk, I., van Lelyveld-Haas, L. E. M., Jansen, T., Nooteboom, F., van der Voort, P. H. J., de Lange, D., Dieperink, W., de Waard, M. C., de Smet, A. G. E., Bormans, L., Dormans, T., Dempsey, G., Mathew, S. J., Raj, A. S., Grecu, I., Cupitt, J., Lawton, T., Clark, R., Popescu, M., Spittle, N., Faulkner, M., Cowton, A., Williams, P., Elloway, E., Reay, M., Chukkambotla, S., Kumar, R., Al-Subaie, N., Kent, L., Tamm, T., Kajtor, I., Burns, K., Pugh, R., Ostermann, M., Kam, E., Bowyer, H., Smith, N., Templeton, M., Henning, J., Goffin, K., Kapoor, R., Laha, S., Chilton, P., Khaliq, W., Crayford, A., Coetzee, S., Tait, M., Stoker, W., Gimenez, M., Pope, A., Camsooksai, J., Pogson, D., Quigley, K., Ritzema, J., Hormis, A., Boulanger, C., Balasubramaniam, M., Vamplew, L., Burt, K., Martin, D., Craig, J., Prowle, J., Doyle, N., Shelton, J., Scott, C., Donnison, P., Shelton, S., Frey, C., Ryan, C., Spray, D., Barnes, V., Barnes, K., Ridgway, S., Saha, R., Clark, T., Wood, J., Bolger, C., Bassford, C., Lewandowski, J., Zhao, X., Humphreys, S., Dowling, S., Richardson, N., Burtenshaw, A., Stevenson, C., Wilcock, D., Nalapko, Y., Helbok, R., Nollet, J., de Neve, N., Mikačić, M., Bastiansen, A., Husted, A., Dahle, B. E. S., Cramer, C., Ørsnes, D., Thomsen, J. Edelberg, Pedersen, J. J., Enevoldsen, M. Hummelmose, Elkmann, T., Kubisz-Pudelko, A., Collins, A., Hart, C., Randell, G., Filipe, H., Welters, I. D., Evans, J., Lord, J., Jones, J., Ball, J., North, J., Salaunkey, K., De Gordoa, L. Ortiz-Ruiz, Bell, L., Vizcaychipi, M., Mupudzi, M., Lea-Hagerty, M., Spivey, M., Love, N., White, N., Morgan, P., Wakefield, P., Savine, R., Jacob, R., Innes, R., Rose, S., Leaver, S., Mane, T., Ogbeide, V., Baird, Y., Romen, A., Galbois, A., Vinsonneau, C., Thevenin, D., Guerot, E., Savary, G., Chagnon, J. L., Rigaud, J. P., Quenot, J. P., Castaneray, J., Rosman, J., Maizel, J., Tiercelet, K., Hovaere, M. M., Messika, M., Djibré, M., Rolin, N., Burtin, P., Garcon, P., Nseir, S., Valette, X., Horacek, M., Bruno, R. Romano, Allgäuer, S., Dubler, S., Schering, S., Koutsikou, A., Vakalos, A., Raitsiou, B., Flioni, E. N., Neou, E., Papathanakos, G., Koutsodimitropoulos, I., Aikaterini, K., Rovina, N., Kourelea, S., Polychronis, T., Zidianakis, V., Konstantinia, V., Read, C., Martin-Loeches, I., Cracchiolo, A. Neville, Morigi, A., Brusa, S., Elhadi, A., Tarek, A., Khaled, A., Ahmed, H., Belkhair, W. Ali, Cornet, A. D., Gommers, D., van Boven, E., Haringman, J., Haas, L., van den Berg, L., Hoiting, O., de Jager, P., Gerritsen, R. T., Breidablik, A., Slapgard, A., Rime, A. K., Jannestad, B., Sjøbøe, B., Rice, E., Jensen, J. P., Langørgen, J., Tøien, K., Strand, K., Biernacka, A., Kluzik, A., Kudlinski, B., Hymczak, H., Solek-Pastuszka, J., Zorska, J., Krzych, Ł. J., Zukowski, M., Lipińska-Gediga, M., Pietruszko, M., Kozera, N., Sendur, P., Zatorski, P., Galkin, P., Kościuczuk, U., Gola, W., Pinto, A. F., Santos, A. R., Ferreira, I. A., Blanco, J. B., Carvalho, J. T., Maia, J., Candeias, N., Lores, A., Cilloniz, C., Perez-Torres, D., Maseda, E., Prol-Silva, E., Eixarch, G., Gomà, G., Velasco, G. Navarro, Jaimes, M. Irazábal, Villamayor, M. Ibarz, Fernández, N. Llamas, Cubero, P. Jimeno, Tomasa, T., Sjöqvist, A., Schiöler, F., Westberg, H., Thiringer, K. Kleiven, Boroli, F., Eckert, P., Yıldız, I., Yovenko, I., for the VIP1, [missing], VIP2 study group, [missing], Fronczek, Jakub, Polok, Kamil, de Lange, Dylan W, Jung, Christian, Beil, Michael, Rhodes, Andrew, Fjølner, Jesper, Górka, Jacek, Andersen, Finn H, Artigas, Antonio, Cecconi, Maurizio, Christensen, Steffen, Joannidis, Michael, Leaver, Susannah, Marsh, Brian, Morandi, Alessandro, Moreno, Rui, Oeyen, Sandra, Agvald-Öhman, Christina, Bollen Pinto, Bernardo, Schefold, Joerg C, Valentin, Andrea, Walther, Sten, Watson, Ximena, Zafeiridis, Tilemacho, Sviri, Sigal, van Heerden, Peter Vernon, Flaatten, Han, Guidet, Bertrand, Szczeklik, Wojciech, R Schmutz, F Wimmer, P Eller, M Joannidis, P De Buysscher, N De Neve, S Oeyen, W Swinnen, B Bollen Pinto, P Abraham, L Hergafi, J C Schefold, E Biskup, P Piza, I Taliadoros, J Fjølner, N Dey, C Sølling, B S Rasmussen, S Christensen, X Forceville, G Besch, H Mentec, P Michel, P Mateu, P Michel, L Vettoretti, J Bourenne, N Marin, M Guillot, N Aissaoui, C Goulenok, N Thieulot-Rolin, J Messika, L Lamhaut, B Guidet, C Charron, A Lauten, A L Sacher, T Brenner, M Franz, F Bloos, H Ebelt, S J Schaller, K Fuest, C Rabe, T Dieck, S Steiner, T Graf, A M Nia, C Jung, R A Janosi, P Meybohm, P Simon, S Utzolino, T Rahmel, E Barth, C Jung, M Schuster, Z Aidoni, S Aloizos, P Tasioudis, K Lampiri, V Zisopoulou, I Ravani, E Pagaki, A Antoniou, T A Katsoulas, A Kounougeri, G Marinakis, F Tsimpoukas, A Spyropoulou, P Zygoulis, A Kyparissi, M Gupta, M Gurjar, I M Maji, I Hayes, B Marsh, Y Kelly, A Westbrook, G Fitzpatrick, D Maheshwari, C Motherway, G Negri, S Spadaro, G Nattino, M Pedeferri, A Boscolo, S Rossi, G Calicchio, L Cubattoli, G Di Lascio, M Barbagallo, F Berruto, D Codazzi, A Bottazzi, P Fumagalli, G Negro, G Lupi, F Savelli, G A Vulcano, R Fumagalli, A Marudi, U Lefons, R Lembo, M Babini, A Paggioro, V Parrini, M Zaccaria, S Clementi, C Gigliuto, F Facondini, S Pastorini, S Munaron, I Calamai, A Bocchi, A Adorni, M G Bocci, A Cortegiani, T Casalicchio, S Mellea, E Graziani, M Barattini, E Brizio, M Rossi, M Hahn, H Flaatten, N Kemmerer, H F Strietzel, K Dybwik, T Legernaes, P Klepstad, E B Olaussen, K I Olsen, O M Brresen, G Bjorsvik, F H Andersen, S Maini, L Fehrle, M Czuczwar, P Krawczyk, M Ziętkiewicz, Ł R Nowak, K Kotfis, K Cwyl, R Gajdosz, J Biernawska, R Bohatyrewicz, R Gawda, P Grudzień, P Nasiłowski, N Popek, W Cyrankiewicz, K Wawrzyniak, M Wnuk, D Maciejewski, D Studzińska, M Żukowski, S Bernas, M Piechota, W Szczeklik, I Nowak-Kózka, J Fronczek, M Serwa, W Machała, J Stefaniak, M Wujtewicz, P Maciejewski, M Szymkowiak, B Adamik, K Polok, J Górka, N Catorze, M C Branco, N Barros, I Barros, A Krystopchuk, T Honrado, C Sousa, F Munoz, M Rebelo, R Gomes, J Nunes, C Dias, A M Fernandes, C Petrisor, B Constantin, V Belskiy, B Boskholov, E Rodriguez, G Aguilar, G Masdeu, M I Jaimes, A P Mira, M A Bodi, J A B Mendoza, S López-Cuenca, M H Guzman, J Rico-Feijoo, M Ibarz, J Trenado Alvarez, R Kawati, J Sivik, J Nauska, D Smole, F Parenmark, J Lyrén, K Rockstroh, S Rydén, M Spångfors, M Strinnholm, S Walther, L De Geer, P Nordlund, S Pålsson, H Zetterquist, A Nilsson, K Thiringer, M Jungner, B Bark, B Nordling, H Sköld, C Brorsson, S Persson, A Bergström, J Berkius, J Holmström, I van Dijk, L E M van Lelyveld-Haas, T Jansen, F Nooteboom, P H J van der Voort, D de Lange, W Dieperink, M C de Waard, A G E de Smet, L Bormans, T Dormans, G Dempsey, S J Mathew, A S Raj, I Grecu, J Cupitt, T Lawton, R Clark, M Popescu, N Spittle, M Faulkner, A Cowton, P Williams, E Elloway, M Reay, S Chukkambotla, R Kumar, N Al-Subaie, L Kent, T Tamm, I Kajtor, K Burns, R Pugh, M Ostermann, E Kam, H Bowyer, N Smith, M Templeton, J Henning, K Goffin, R Kapoor, S Laha, P Chilton, W Khaliq, A Crayford, S Coetzee, M Tait, W Stoker, M Gimenez, A Pope, J Camsooksai, D Pogson, K Quigley, J Ritzema, A Hormis, C Boulanger, M Balasubramaniam, L Vamplew, K Burt, D Martin, I Grecu, J Craig, J Prowle, N Doyle, J Shelton, C Scott, P Donnison, S Shelton, C Frey, C Ryan, D Spray, C Ryan, V Barnes, K Barnes, S Ridgway, R Saha, L Kent, T Clark, J Wood, C Bolger, C Bassford, A Cowton, J Lewandowski, X Zhao, S Humphreys, S Dowling, N Richardson, A Burtenshaw, C Stevenson, D Wilcock, Y Nalapko, M Joannidis, P Eller, R Helbok, R Schmutz, J Nollet, N de Neve, P De Buysscher, S Oeyen, W Swinnen, M Mikačić, A Bastiansen, A Husted, B E S Dahle, C Cramer, C Sølling, D Ørsnes, J Edelberg Thomsen, J J Pedersen, M Hummelmose Enevoldsen, T Elkmann, A Kubisz-Pudelko, A Pope, A Collins, A S Raj, C Boulanger, C Frey, C Hart, C Bolger, D Spray, G Randell, H Filipe, I D Welters, I Grecu, J Evans, J Cupitt, J Lord, J Henning, J Jones, J Ball, J North, K Salaunkey, L Ortiz-Ruiz De Gordoa, L Bell, M Balasubramaniam, M Vizcaychipi, M Faulkner, M Mupudzi, M Lea-Hagerty, M Reay, M Spivey, N Love, N Spittle, N White, P Williams, P Morgan, P Wakefield, R Savine, R Jacob, R Innes, R Kapoor, S Humphreys, S Rose, S Dowling, S Leaver, T Mane, T Lawton, V Ogbeide, W Khaliq, Y Baird, A Romen, A Galbois, B Guidet, C Vinsonneau, C Charron, D Thevenin, E Guerot, G Besch, G Savary, H Mentec, J L Chagnon, J P Rigaud, J P Quenot, J Castaneray, J Rosman, J Maizel, K Tiercelet, L Vettoretti, M M Hovaere, M Messika, M Djibré, N Rolin, P Burtin, P Garcon, S Nseir, X Valette, C Rabe, E Barth, H Ebelt, K Fuest, M Franz, M Horacek, M Schuster, P Meybohm, R Romano Bruno, S Allgäuer, S Dubler, S J Schaller, S Schering, S Steiner, T Dieck, T Rahmel, T Graf, A Koutsikou, A Vakalos, B Raitsiou, E N Flioni, E Neou, F Tsimpoukas, G Papathanakos, G Marinakis, I Koutsodimitropoulos, K Aikaterini, N Rovina, S Kourelea, T Polychronis, V Zidianakis, V Konstantinia, Z Aidoni, B Marsh, C Motherway, C Read, I Martin-Loeches, A Neville Cracchiolo, A Morigi, I Calamai, S Brusa, A Elhadi, A Tarek, A Khaled, H Ahmed, W Ali Belkhair, A D Cornet, D Gommers, D de Lange, E van Boven, J Haringman, L Haas, L van den Berg, O Hoiting, P de Jager, R T Gerritsen, T Dormans, W Dieperink, A Breidablik, A Slapgard, A K Rime, B Jannestad, B Sjøbøe, E Rice, F H Andersen, H F Strietzel, J P Jensen, J Langørgen, K Tøien, K Strand, M Hahn, P Klepstad, A Biernacka, A Kluzik, B Kudlinski, D Maciejewski, D Studzińska, H Hymczak, J Stefaniak, J Solek-Pastuszka, J Zorska, K Cwyl, Ł J Krzych, M Zukowski, M Lipińska-Gediga, M Pietruszko, M Piechota, M Serwa, M Czuczwar, M Ziętkiewicz, N Kozera, P Nasiłowski, P Sendur, P Zatorski, P Galkin, R Gawda, U Kościuczuk, W Cyrankiewicz, W Gola, A F Pinto, A M Fernandes, A R Santos, C Sousa, I Barros, I A Ferreira, J B Blanco, J T Carvalho, J Maia, N Candeias, N Catorze, V Belskiy, A Lores, A P Mira, C Cilloniz, D Perez-Torres, E Maseda, E Rodriguez, E Prol-Silva, G Eixarch, G Gomà, G Aguilar, G Navarro Velasco, M Irazábal Jaimes, M Ibarz Villamayor, N Llamas Fernández, P Jimeno Cubero, S López-Cuenca, T Tomasa, A Sjöqvist, C Brorsson, F Schiöler, H Westberg, J Nauska, J Sivik, J Berkius, K Kleiven Thiringer, L De Geer, S Walther, F Boroli, J C Schefold, L Hergafi, P Eckert, I Yıldız, I Yovenko, Y Nalapko, R Pugh, and Critical Care

Subjects
Male, Short term mortality, Critical Care and Intensive Care Medicine, Cohort Studies, 0302 clinical medicine, kwetsbaarheid, Medicine and Health Sciences, 80 and over, Medicine, 610 Medicine & health, Prospective cohort study, Correlation of Data, 11 Medical and Health Sciences, Aged, 80 and over, OUTCOMES, Intensive care units, Frailty, VIP1, Aged,&nbsp, Medical emergencies. Critical care. Intensive care. First aid, Scale (social sciences), Female, prospectief onderzoek, Life Sciences & Biomedicine, CRITICALLY-ILL PATIENTS, Study groups, medicine.medical_specialty, Anestesi och intensivvård, 80 jaar en ouder, INTENSIVE-CARE, BED AVAILABILITY, NO, 03 medical and health sciences, Critical Care Medicine, Intensive care, sterfte, General & Internal Medicine, Humans, Aged, Prospective studies, Mortality, In patient, ddc:610, Intensive Care Units, Logistic Models, Prospective Studies, Science & Technology, Anesthesiology and Intensive Care, business.industry, RC86-88.9, Research, 030208 emergency & critical care medicine, ADULTS, Aged, 80 and over, Emergency & Critical Care Medicine, 030228 respiratory system, intensivecareafdelingen, Critical illness, Emergency medicine, VIP2 study group, &nbsp, CRITICAL ILLNESS, business
Abstract

Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p p Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Published
2021
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11. Provision of critical care for the elderly in Europe

Author

Wernly, B, Beil, M, Bruno, RR, Binnebössel, S, Kelm, M, Sigal, S, van Heerden, PV, Boumendil, A, Artigas, A, Cecconi, M, Marsh, B, Moreno, R, Oeyen, S, Bollen Pinto, B, Szczeklik, W, Leaver, S, Walther, SM, Schefold, JC, Joannidis, M, Fjølner, J, Zafeiridis, T, de Lange, D, Guidet, B, Flaatten, H, Jung, C, VIP2 study group, and Critical Care

Subjects
law.invention, 0302 clinical medicine, law, Health care, Medicine and Health Sciences, 030212 general & internal medicine, adult intensive & critical care, public health, geriatric medicine, 610 Medicine & health, humans, Geriatrics, education.field_of_study, General Medicine, OLDER PERSONS, Intensive care unit, Intensive Care Units, aged, retrospective studies, iIntensive care units, europe, Europa, kritieke ziekte, Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, medicine.medical_specialty, ziekenhuismortaliteit, Population, 03 medical and health sciences, length of stay, Intensive care, mensen, ouderen, medicine, critical illness, Social determinants of health, education, FRAILTY, intensive care ouderen, hospital mortality, business.industry, Public health, Other Research Radboud Institute for Health Sciences [Radboudumc 0], fungi, Intensive Care, 030208 emergency & critical care medicine, Retrospective cohort study, Health Care Service and Management, Health Policy and Services and Health Economy, critical care, delivery of health Care, kritieke zorg, ICU, business, duur van opname, Demography
Abstract

ObjectivesIn Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SettingICUs in 16 European countries.ParticipantsIn total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measuresWe chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.ResultsIn SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; pConclusionsThe 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.Trial registration numbersNCT03134807 and NCT03370692.

Published
2021
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12. Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study

Author

Ibarz, Mercedes, Boumendil, Ariane, Haas, Lenneke E M, Irazabal, Marian, Flaatten, Hans, de Lange, Dylan W, Morandi, Alessandro, Andersen, Finn H, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Bollen Pinto, Bernardo, Soliman, Ivo W, Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Artigas, Antonio, Schmutz R, Wimmer F, Eller P, Joannidis M, De Buysscher P, De Neve N, Oeyen S, Swinnen W, Bollen Pinto B, Abraham P, Hergafi L, Schefold JC, Biskup E, Piza P, Taliadoros I, Fjølner J, Dey N, Sølling C, Rasmussen BS, Christensen S, Forceville X, Besch G, Mentec H, Michel P, Mateu P, Vettoretti L, Bourenne J, Marin N, Guillot M, Aissaoui N, Goulenok C, Thieulot-Rolin N, Messika J, Lamhaut L, Guidet B, Charron C, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Nia AM, Jung C, Janosi RA, Meybohm P, Simon P, Utzolino S, Rahmel T, Barth E, Schuster M, Aidoni Z, Aloizos S, Tasioudis P, Lampiri K, Zisopoulou V, Ravani I, Pagaki E, Antoniou A, Katsoulas TA, Kounougeri A, Marinakis G, Tsimpoukas F, Spyropoulou A, Zygoulis P, Kyparissi A, Gupta M, Gurjar M, Maji IM, Hayes I, Marsh B, Kelly Y, Westbrook A, Fitzpatrick G, Maheshwari D, Motherway C, Negri G, Spadaro S, Nattino G, Pedeferri M, Boscolo A, Rossi S, Calicchio G, Cubattoli L, Di Lascio G, Barbagallo M, Berruto F, Codazzi D, Bottazzi A, Fumagalli P, Negro G, Lupi G, Savelli F, Vulcano GA, Fumagalli R, Marudi A, Lefons U, Lembo R, Babini M, Paggioro A, Parrini V, Zaccaria M, Clementi S, Gigliuto C, Facondini F, Pastorini S, Munaron S, Calamai I, Bocchi A, Adorni A, Bocci MG, Cortegiani A, Casalicchio T, Melia S, Graziani E, Barattini M, Brizio E, Rossi M, Hahn M, Flattens H, Kemmerer N, Streiter HF, Dybwik K, Legernaes T, Klepstad P, Olaussen EB, Olsen KI, Brresen OM, Bjorsvik G, Andersen FH, Maini S, Fehrle L, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Kotfis K, Cwyl K, Gajdosz R, Biernawska J, Bohatyrewicz R, Gawda R, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Żukowski M, Bernas S, Piechota M, Szczeklik W, Nowak-Kózka I, Fronczek J, Serwa M, Machała W, Stefaniak J, Wujtewicz M, Szymkowiak M, Adamik B, Polok K, Włudarczyk A, Górka J, Kozera N, Goździk W, Catorze N, Branco MC, Barros I, Barros N, Krystopchuk A, Honrado T, Sousa C, Munoz F, Rebelo M, Gomes R, Nunes J, Dias C, Fernandes AM, Petrisor C, Constantin B, Belskiy V, Boskholov B, Rodriguez E, Rebollo S, Aguilar G, Masdeu G, Jaimes MI, Mira ÁP, Bodi MA, Barea Mendoza JA, López-Cuenca S, Guzman MH, Rico-Feijoo J, Ibarz M, Alvarez JT, Kawati R, Sivik J, Nauska J, Smole D, Parenmark F, Lyrén J, Rockstrohm K, Rydén S, Spångfors M, Strinnholm M, Walther S, De Geer L, Nordlund P, Pålsson S, Zetterquist H, Nilsson A, Thiringer K, Jungner M, Bark B, Nordling B, Sköld H, Brorsson C, Persson S, Bergström A, Berkius J, Holmström J, van Dijk I, Haas LEM, Ramnarain D, Jansen T, Nooteboom F, van der Voort PHJ, de Lange D, Dieperink W, de Waard MC, de Smet AGE, Bormans L, Dormans T, Dempsey G, Mathew SJ, Raj AS, Grecu I, Cupitt J, Lawton T, Clark R, Popescu M, Spittle N, Faulkner M, Cowton A, Elloway E, Williams P, Reay M, Chukkambotla S, Kumar R, Al-Subaie N, Kent L, Tamm T, Kajtor I, Burns K, Pugh R, Ostermann M, Kam E, Bowyer H, Smith N, Templeton M, Henning J, Goffin K, Kapoor R, Laha S, Chilton P, Khaliq W, Crayford A, Coetzee S, Tait M, Stoker W, Gimenez M, Pope A, Camsooksai J, Pogson D, Quigley K, Ritzema J, Hormis A, Boulanger C, Balasubramaniam M, Vamplew L, Burt K, Martin D, Craig J, Prowle J, Doyle N, Shelton J, Scott C, Donnison P, Shelton S, Frey C, Ryan C, Spray D, Barnes V, Barnes K, Ridgway S, Saha R, Clark T, Wood J, Bolger C, Bassford C, Lewandowski J, Zhao X, Humphreys S, Dowling S, Richardson N, Burtenshaw A, Stevenson C, Wilcock D, Nalapko Y., Ibarz, M, Boumendil, A, Haas, L, Irazabal, M, Flaatten, H, de Lange, D, Morandi, A, Andersen, F, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Bollen Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Artigas, A, Schmutz, R, Wimmer, F, Eller, P, Joannidis, M, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Schefold, J, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ravani, I, Pagaki, E, Antoniou, A, Katsoulas, T, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Melia, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Flattens, H, Kemmerer, N, Streiter, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Fronczek, J, Serwa, M, Stefaniak, J, Wujtewicz, M, Szymkowiak, M, Adamik, B, Polok, K, Wludarczyk, A, Gorka, J, Kozera, N, Gozdzik, W, Catorze, N, Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Parenmark, F, Lyren, J, Rockstrohm, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Nalapko, Y, Ibarz, Mercede, Boumendil, Ariane, Haas, Lenneke E M, Irazabal, Marian, Flaatten, Han, de Lange, Dylan W, Morandi, Alessandro, Andersen, Finn H, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Bollen Pinto, Bernardo, Soliman, Ivo W, Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zaferidis, Tilemacho, Guidet, Bertrand, Artigas, Antonio, Schmutz R, Wimmer F, Eller P, Joannidis M, De Buysscher P, De Neve N, Oeyen S, Swinnen W, Bollen Pinto B, Abraham P, Hergafi L, Schefold JC, Biskup E, Piza P, Taliadoros I, Fjølner J, Dey N, Sølling C, Rasmussen BS, Christensen S, Forceville X, Besch G, Mentec H, Michel P, Mateu P, Michel P, Vettoretti L, Bourenne J, Marin N, Guillot M, Aissaoui N, Goulenok C, Thieulot-Rolin N, Messika J, Lamhaut L, Guidet B, Charron C, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Nia AM, Jung C, Janosi RA, Meybohm P, Simon P, Utzolino S, Rahmel T, Barth E, Jung C, Schuster M, Aidoni Z, Aloizos S, Tasioudis P, Lampiri K, Zisopoulou V, Ravani I, Pagaki E, Antoniou A, Katsoulas TA, Kounougeri A, Marinakis G, Tsimpoukas F, Spyropoulou A, Zygoulis P, Kyparissi A, Gupta M, Gurjar M, Maji IM, Hayes I, Marsh B, Kelly Y, Westbrook A, Fitzpatrick G, Maheshwari D, Motherway C, Negri G, Spadaro S, Nattino G, Pedeferri M, Boscolo A, Rossi S, Calicchio G, Cubattoli L, Di Lascio G, Barbagallo M, Berruto F, Codazzi D, Bottazzi A, Fumagalli P, Negro G, Lupi G, Savelli F, Vulcano GA, Fumagalli R, Marudi A, Lefons U, Lembo R, Babini M, Paggioro A, Parrini V, Zaccaria M, Clementi S, Gigliuto C, Facondini F, Pastorini S, Munaron S, Calamai I, Bocchi A, Adorni A, Bocci MG, Cortegiani A, Casalicchio T, Melia S, Graziani E, Barattini M, Brizio E, Rossi M, Hahn M, Flattens H, Kemmerer N, Streiter HF, Dybwik K, Legernaes T, Klepstad P, Olaussen EB, Olsen KI, Brresen OM, Bjorsvik G, Andersen FH, Maini S, Fehrle L, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Kotfis K, Cwyl K, Gajdosz R, Biernawska J, Bohatyrewicz R, Gawda R, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Żukowski M, Bernas S, Piechota M, Szczeklik W, Nowak-Kózka I, Fronczek J, Serwa M, Machała W, Stefaniak J, Wujtewicz M, Szymkowiak M, Adamik B, Polok K, Włudarczyk A, Górka J, Kozera N, Goździk W, Catorze N, Branco MC, Barros I, Barros N, Krystopchuk A, Honrado T, Sousa C, Munoz F, Rebelo M, Gomes R, Nunes J, Dias C, Fernandes AM, Petrisor C, Constantin B, Belskiy V, Boskholov B, Rodriguez E, Rebollo S, Aguilar G, Masdeu G, Jaimes MI, Mira ÁP, Bodi MA, Barea Mendoza JA, López-Cuenca S, Guzman MH, Rico-Feijoo J, Ibarz M, Alvarez JT, Kawati R, Sivik J, Nauska J, Smole D, Parenmark F, Lyrén J, Rockstrohm K, Rydén S, Spångfors M, Strinnholm M, Walther S, De Geer L, Nordlund P, Pålsson S, Zetterquist H, Nilsson A, Thiringer K, Jungner M, Bark B, Nordling B, Sköld H, Brorsson C, Persson S, Bergström A, Berkius J, Holmström J, van Dijk I, Haas LEM, Ramnarain D, Jansen T, Nooteboom F, van der Voort PHJ, de Lange D, Dieperink W, de Waard MC, de Smet AGE, Bormans L, Dormans T, Dempsey G, Mathew SJ, Raj AS, Grecu I, Cupitt J, Lawton T, Clark R, Popescu M, Spittle N, Faulkner M, Cowton A, Elloway E, Williams P, Reay M, Chukkambotla S, Kumar R, Al-Subaie N, Kent L, Tamm T, Kajtor I, Burns K, Pugh R, Ostermann M, Kam E, Bowyer H, Smith N, Templeton M, Henning J, Goffin K, Kapoor R, Laha S, Chilton P, Khaliq W, Crayford A, Coetzee S, Tait M, Stoker W, Gimenez M, Pope A, Camsooksai J, Pogson D, Quigley K, Ritzema J, Hormis A, Boulanger C, Balasubramaniam M, Vamplew L, Burt K, Martin D, Grecu I, Craig J, Prowle J, Doyle N, Shelton J, Scott C, Donnison P, Shelton S, Frey C, Ryan C, Spray D, Ryan C, Barnes V, Barnes K, Ridgway S, Saha R, Kent L, Clark T, Wood J, Bolger C, Bassford C, Cowton A, Lewandowski J, Zhao X, Humphreys S, Dowling S, Richardson N, Burtenshaw A, Stevenson C, Wilcock D, Nalapko Y., Critical Care, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
INTENSIVE-CARE-UNIT, Survival, HSJ UCI, Critical Care and Intensive Care Medicine, survival analysis, law.invention, sepsis, Severity of illne, 0302 clinical medicine, LONG-TERM OUTCOMES, overlevingsanalyse, law, Medicine and Health Sciences, EPIDEMIOLOGY, Intensive care, Mortality, Outcome, Sepsis, Severity of illness, Very old, 030212 general & internal medicine, Prospective cohort study, ELDERLY-PATIENTS, ddc:617, PATIENTS AGED 80, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Very Old, Intensive care unit, SOFA score, medicine.symptom, CRITICALLY-ILL PATIENTS, WITHDRAWAL, hormones, hormone substitutes, and hormone antagonists, medicine.medical_specialty, Sepsi, elderly patients, NO, 03 medical and health sciences, sterfte, Internal medicine, medicine, FRAILTY, business.industry, Septic shock, Research, SEPTIC SHOCK, Organ dysfunction, Intensive Care, 030208 emergency & critical care medicine, lcsh:RC86-88.9, oudere patiënten, medicine.disease, business
Abstract

BackgroundThe number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.ResultsThis prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7,p p p p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15),p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17),p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1),p = 0.85].ConclusionsAfter adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

Published
2020

13. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author

Jung, C., Flaatten, H., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Leaver, S., Boumendil, A., Zegers, M., Lange, D.W. de, and Guidet, B.

Subjects
Male, COVID-19 / mortality, Letter, Critical Care, Frail Elderly, HSJ UCI, Frailty / mortality, Critical Care and Intensive Care Medicine, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Elderly, Medicine and Health Sciences, Humans, Prospective Studies, Outcome, Aged, Aged, 80 and over, Pandemia, Frailty, RC86-88.9, COVID-19, Frail Elderly / statistics & numerical data, Medical emergencies. Critical care. Intensive care. First aid, Prognosis, Survival Analysis, COVID-19 / therapy, Female
Abstract

Contains fulltext : 238691.pdf (Publisher’s version ) (Open Access) 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

Published
2021

14. Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

Author

Wernly, B., Beil, M., Bruno, R.R., Binnebössel, S., Kelm, M., Sigal, S., Heerden, P.V. van, Boumendil, A., Artigas, A., Cecconi, M., Marsh, B., Moreno, R., Oeyen, S., Pinto, B. Bollen, Szczeklik, W., Leaver, S., Walther, S.M., Schefold, J.C., Joannidis, M., Fjølner, J., Zafeiridis, T., Lange, D. de, Guidet, B., Nollet, J.L., Flaatten, H., Jung, C., Wernly, B., Beil, M., Bruno, R.R., Binnebössel, S., Kelm, M., Sigal, S., Heerden, P.V. van, Boumendil, A., Artigas, A., Cecconi, M., Marsh, B., Moreno, R., Oeyen, S., Pinto, B. Bollen, Szczeklik, W., Leaver, S., Walther, S.M., Schefold, J.C., Joannidis, M., Fjølner, J., Zafeiridis, T., Lange, D. de, Guidet, B., Nollet, J.L., Flaatten, H., and Jung, C.

Abstract

Contains fulltext : 245101.pdf (Publisher’s version ) (Open Access), OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI. SETTING: ICUs in 16 European countries. PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems. PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies. RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings. CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations. TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.

Published
2021

15. Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

Author

Jung, C., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., Flaatten, H., Jung, C., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., and Flaatten, H.

Abstract

Contains fulltext : 238632.pdf (Publisher’s version ) (Open Access), 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 PaO(2)/FiO(2) 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.

Published
2021

16. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients

Author

Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Binnebössel, S., Baldia, P.H., Kelm, M., Beil, M., Sigal, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., Jung, C., Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Binnebössel, S., Baldia, P.H., Kelm, M., Beil, M., Sigal, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., and Jung, C.

Abstract

Contains fulltext : 238800.pdf (Publisher’s version ) (Open Access), 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 i

Published
2021

17. Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU

Author

Krag, Mette, Marker, Søren, Perner, Anders, Wetterslev, Jørn, Wise, Matt P, Schefold, Joerg C, Keus, Frederik, Guttormsen, Anne B, Bendel, Stepani, Borthwick, Mark, Lange, Theis, Rasmussen, Bodil S, Siegemund, Martin, Bundgaard, Helle, Elkmann, Thomas, Jensen, Jacob V, Nielsen, Rune D, Liboriussen, Lisbeth, Bestle, Morten H, Elkjær, Jeanie M, Palmqvist, Dorte F, Bäcklund, Minna, Laake, Jon H, Bådstøløkken, Per M, Grönlund, Juha, Breum, Olena, Walli, Akil, Winding, Robert, Iversen, Susanne, Jarnvig, Inge-Lise, White, Jonathan O, Brand, Björn, Madsen, Martin B, Quist, Lars, Thornberg, Klaus J, Møller, Anders, Wiis, Jørgen, Granholm, Anders, Anthon, Carl T, Meyhoff, Tine S, Hjortrup, Peter B, Aagaard, Søren R, Andreasen, Jo B, Sørensen, Christina A, Haure, Pernille, Hauge, Jacob, Hollinger, Alexa, Scheuzger, Jonas, Tuchscherer, Daniel, Vuilliomenet, T, Takala, J, Jakob, S. M., Vang, M. L., Pælestik, K. B., Andersen, K. L. D., van der Horst, I. C. C., Dieperink, W., Fjølner, J., Kjer, C. K. W., Sølling, C, Sølling, C. G., Karttunen, J., Morgan, M. P. G., Sjøbø, B., Engstrøm, J., Agerholm-Larsen, B, Møller, Morten H, Rasmussen, Bodil Steen, Aagaard, Søren Rosborg, Bønding Andreasen, Jo, Ankjær Sørensen, Christina, Christensen, Pernille Haure, Levin, Marianne, Klemmesen Jensen, Käte, Lundberg, Lillian Skov Søndergaard, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Cardiovascular Centre (CVC), and Critical Care

Subjects
Pantoprazole/adverse effects, Male, INTENSIVE-CARE-UNIT, intraveneuze injecties, law.invention, Proton Pump Inhibitors/adverse effects, intensive care afdelingen, 0302 clinical medicine, Randomized controlled trial, law, overlevingsanalyse, Risk Factors, adults, Medicine, maagzweren, Artikkel, Single-Blind Method, 030212 general & internal medicine, 610 Medicine & health, Pantoprazole, enkele blindering, volwassenen, General Medicine, Middle Aged, Intensive care unit, Intensive Care Units, Injections, Intravenous, STRESS-ULCER PROPHYLAXIS, Female, psychosocial stress, Gastrointestinal Hemorrhage, kritieke ziekte, medicine.drug, medicine.medical_specialty, Gastrointestinal bleeding, risicofactoren, Peptic Ulcer, Randomization, bijwerkingen, Gastrointestinal Hemorrhage/epidemiology, Critical Illness, Placebo, Peptic Ulcer/prevention & control, psychosociale stress, PROTON-PUMP INHIBITORS, 03 medical and health sciences, Medisinske Fag: 700 [VDP], Stress, Physiological, Internal medicine, SCORE, Humans, VDP::Medisinske Fag: 700, Aged, gastro-intestinale bloeding, SEPSIS, business.industry, intravenous injections, 030208 emergency & critical care medicine, Proton Pump Inhibitors, pantaprazole, ta3121, medicine.disease, Survival Analysis, Confidence interval, Critical Illness/mortality, Relative risk, adverse effects, business, single-blind methoden, protonpompremmers
Abstract

Background\ud\udProphylaxis for gastrointestinal stress ulceration is frequently given to patients in the intensive care unit (ICU), but its risks and benefits are unclear.\udMethods\ud\udIn this European, multicenter, parallel-group, blinded trial, we randomly assigned adults who had been admitted to the ICU for an acute condition (i.e., an unplanned admission) and who were at risk for gastrointestinal bleeding to receive 40 mg of intravenous pantoprazole (a proton-pump inhibitor) or placebo daily during the ICU stay. The primary outcome was death by 90 days after randomization.\udResults\ud\udA total of 3298 patients were enrolled; 1645 were randomly assigned to the pantoprazole group and 1653 to the placebo group. Data on the primary outcome were available for 3282 patients (99.5%). At 90 days, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died (relative risk, 1.02; 95% confidence interval [CI], 0.91 to 1.13; P=0.76). During the ICU stay, at least one clinically important event (a composite of clinically important gastrointestinal bleeding, pneumonia, Clostridium difficile infection, or myocardial ischemia) had occurred in 21.9% of patients assigned to pantoprazole and 22.6% of those assigned to placebo (relative risk, 0.96; 95% CI, 0.83 to 1.11). In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, as compared with 4.2% in the placebo group. The number of patients with infections or serious adverse reactions and the percentage of days alive without life support within 90 days were similar in the two groups.\udConclusions\ud\udAmong adult patients in the ICU who were at risk for gastrointestinal bleeding, mortality at 90 days and the number of clinically important events were similar in those assigned to pantoprazole and those assigned to placebo. (Funded by Innovation Fund Denmark and others; SUP-ICU ClinicalTrials.gov number, NCT02467621. opens in new tab.)

Published
2018
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18. [Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest]

Author

Obling L, Wiberg S, Je, Møller, Hassager C, christian juhl terkelsen, Holmvang L, Aarøe J, Møller-Sørensen H, Fjølner J, Ss, Rudolph, and Kjaergaard J

Subjects
Editorial, Extracorporeal Membrane Oxygenation, Time Factors, Patient Selection, Humans, English Abstract, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest
Abstract

Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of eCPR focussing on current knowledge of criteria for selection of relevant patients for treatment.

Published
2017

22. 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

Author

Soliman, Ivo, Leaver, Susannah, Flaatten, Hans, Fjølner, Jesper, Wernly, Bernhard, Bruno, Raphael, Artigas, Antonio, Bollen Pinto, Bernardo, Schefold, Joerg, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Zafeiridis, Tilemachos, Wollborn, Jakob, Banzo, Maria Jose Arche, Fuest, Kristina, Marsh, Brian, Andersen, Finn, Moreno, Rui, Boumendil, Ariane, Guidet, Bertrand, Jung, Christian, de Lange, Dylan, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Brix, Helene, Brushoej, Jens, Villefrance, Maja, Nedergaard, Helene Korvenius, Bjerregaard, Anders Thais, Balleby, Ida Riise, Andersen, Kasper, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Mohamed, Aliae Ar Hussein, Salah, Rehab, Ali, Yasmin Khairy Nasreldin Mohamed, Wassim, Kyrillos, Elgazzar, Yumna, Tharwat, Samar, Azzam, Ahmed, Habib, Ayman Abdelmawgoad, Abosheaishaa, Hazem Maarouf, Azab, Mohammed, Galbois, Arnaud, Charron, Cyril, Guerot, Emmanuel, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Bruno, Caillard, Anais, Valent, Arnaud, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Raphaelen, Jean-Herlé, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Piton, Gaël, Bruno, Raphael Romano, Kelm, Malte, Wolff, Georg, Barth, Eberhard, Goebel, Ulrich, Kunstein, Anselm, Schuster, Michael, Welte, Martin, Lutz, Matthias, Meybohm, Patrick, Steiner, Stephan, Poerner, Tudor, Haake, Hendrik, Schaller, Stefan, Kindgen-Milles, Detlef, Meyer, Christian, Kurt, Muhammed, Kuhn, Karl Friedrich, Randerath, Winfried, Dindane, Zouhir, Kabitz, Hans-Joachim, Voigt, Ingo, Shala, Gonxhe, Faltlhauser, Andreas, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Papadogoulas, Antonios, Gurjar, Mohan, Mahmoodpoor, Ata, Ahmed, Abdullah Khudhur, Elsaka, Ahmed, Comellini, Vittoria, Rabha, Ahmed, Ahmed, Hazem, Namendys-Silva, Silvio, Ghannam, Abdelilah, Groenendijk, Martijn, Zegers, Marieke, Cornet, Alex, Evers, Mirjam, Haas, Lenneke, Dormans, Tom, Dieperink, Willem, Romundstad, Luis, Sjøbø, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Hahn, Michael, Czuczwar, Miroslaw, Gawda, Ryszard, Klimkiewicz, Jakub, de Lurdessantos, Maria Campos, Gordinho, André, Santos, Henrique, Assis, Rui, Oliveira, Ana Isabel Pinho, Badawy, Mohamed Raafat, Perez-Torres, David, Gomà, Gemma, Villamayor, Mercedes Ibarz, Mira, Angela Prado, Cubero, Patricia Jimeno, Rivera, Susana Arias, Tomasa, Teresa, Iglesias, David, Vázquez, Eric Mayor, Aldecoa, Cesar, Ferreira, Aida Fernández, Zalba-Etayo, Begoña, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, Sancho, Susana, Priego, Jesús, Abualqumboz, Enas, Hilles, Momin Majed Yousuf, Saleh, Mahmoud, Ben-Hamouda, Nawfel, Roberti, Andrea, Dullenkopf, Alexander, Fleury, Yvan, Pinto, Bernardo Bollen, Al-Sadawi, Mohammed, Serck, Nicolas, Dewaele, Elisabeth, Kumar, Pritpal, Bundesen, Camilla, Innes, Richard, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Humphreys, Sally, Berlemont, Caroline Hauw, Chousterman, Benjamin Glenn, Dépret, François, Ferre, Alexis, Vettoretti, Lucie, Thevenin, Didier, Milovanovic, Milena, Simon, Philipp, Lorenz, Marco, Stoll, Sandra Emily, Dubler, Simon, Mulita, Francesk, Kondili, Eumorifa, Andrianopoulos, Ioannis, Meynaar, Iwan, Cornet, Alexander Daniel, Sjøbøe, Britt, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Solek-Pastuszka, Joanna, Onichimowski, Dariusz, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Cardoso, Filipe Sousa, Banzo, Maria José Arche, Tomasa-Irriguible, Teresa Maria, Mira, Ángela Prado, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, de Gopegui, Pablo Ruiz, Abidi, Nour, Chau, Ivan, Pugh, Richard, Smuts, Sara, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Bouchard, Mélanie, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), COVIP-study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Brix, H., Brushoej, J., Villefrance, M., Nedergaard, H.K., Bjerregaard, A.T., Balleby, I.R., Andersen, K., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Mohamed, AAH, Salah, R., Ali, YKNM, Wassim, K., Elgazzar, Y.A., Tharwat, S., Azzam, A.Y., Habib, A.A., Abosheaishaa, H.M., Azab, M.A., Leaver, S., Galbois, A., Guidet, B., Charron, C., Guerot, E., Besch, G., Rigaud, J.P., 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., Raphaelen, J.H., Dauger, S., Dumas, G., Goncalves, B., Piton, G., Jung, C., Bruno, R.R., Kelm, M., Wolff, G., Barth, E., Goebel, U., Kunstein, A., Schuster, M., Welte, M., Lutz, M., Meybohm, P., Steiner, S., Poerner, T., Haake, H., Schaller, S., Kindgen-Milles, D., Meyer, C., Kurt, M., Kuhn, K.F., Randerath, W., Wollborn, J., Dindane, Z., Kabitz, H.J., Voigt, I., Shala, G., Faltlhauser, A., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Papadogoulas, A., Gurjar, M., Mahmoodpoor, A., Ahmed, A.K., Marsh, B., Elsaka, A., Sviri, S., Comellini, V., Rabha, A., Ahmed, H., Namendys-Silva, S.A., Ghannam, A., Groenendijk, M., Zegers, M., de Lange, D., Cornet, A., Evers, M., Haas, L., Dormans, T., Dieperink, W., Romundstad, L., Sjøbø, B., Andersen, F.H., Strietzel, H.F., Olasveengen, T., Hahn, M., Czuczwar, M., Gawda, R., Klimkiewicz, J., de LurdesSantos, M.C., Gordinho, A., Santos, H., Assis, R., Oliveira, AIP, Badawy, M.R., Perez-Torres, D., Gomà, G., Villamayor, M.I., Mira, A.P., Cubero, P.J., Rivera, S.A., Tomasa, T., Iglesias, D., Vázquez, E.M., Aldecoa, C., Ferreira, A.F., 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., Pinto, B.B., Schefold, J.C., Al-Sadawi, M., Serck, N., Dewaele, E., Kumar, P., Bundesen, C., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Humphreys, S., Berlemont, C.H., Chousterman, B.G., Dépret, F., Ferre, A., Vettoretti, L., Thevenin, D., Milovanovic, M., Simon, P., Lorenz, M., Stoll, S.E., Dubler, S., Fuest, K., Mulita, F., Kondili, E., Andrianopoulos, I., Meynaar, I., Cornet, A.D., Sjøbøe, B., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Solek-Pastuszka, J., Onichimowski, D., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Cardoso, F.S., Banzo, MJA, Tomasa-Irriguible, T.M., Mira, Á.P., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., de Gopegui, P.R., Abidi, N., Chau, I., Pugh, R., and Smuts, S.

Subjects
Aging, Activities of Daily Living, Aged, COVID-19, Humans, Intensive Care Units, Prospective Studies, Quality of Life, SARS-CoV-2, Intensive Care Unit (ICU), Older people, Survival, frailty, [SDV]Life Sciences [q-bio], SOCIETY, 610 Medicine & health, General Medicine, INTENSIVE-CARE, humanities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], [SDV] Life Sciences [q-bio], Medicine and Health Sciences, Geriatrics and Gerontology
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.

Published
2022
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23. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Author

Bruno, Raphael Romano, Wernly, Bernhard, Flaatten, Hans, Fjølner, Jesper, Artigas, Antonio, Baldia, Philipp Heinrich, Binneboessel, Stephan, Bollen Pinto, Bernardo, Schefold, Joerg C., Wolff, Georg, Kelm, Malte, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Kondili, Eumorfia, Marsh, Brian, Wollborn, Jakob, Andersen, Finn H., Moreno, Rui, Leaver, Susannah, Boumendil, Ariane, De Lange, Dylan W., Guidet, Bertrand, Jung, Christian, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Serck, Nicolas, Dewaele, Elisabeth, Brix, Helene, Brushoej, Jens, Kumar, Pritpal, Nedergaard, Helene Korvenius, Balleby, Ida Riise, Bundesen, Camilla, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Abusayed, Mohammed Abdelshafy, Humphreys, Sally, Galbois, Arnaud, Charron, Cyril, Berlemont, Caroline Hauw, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Buno, Chousterman, Benjamin Glenn, Dépret, François, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Ferre, Alexis, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Vettoretti, Lucie, Thevenin, Didier, Schaller, Stefan, Kurt, Muhammed, Faltlhauser, Andreas, Meyer, Christian, Milovanovic, Milena, Lutz, Matthias, Shala, Gonxhe, Haake, Hendrik, Randerath, Winfried, Kunstein, Anselm, Meybohm, Patrick, Steiner, Stephan, Barth, Eberhard, Poerner, Tudor, Simon, Philipp, Lorenz, Marco, Dindane, Zouhir, Kuhn, Karl Friedrich, Welte, Martin, Voigt, Ingo, Kabitz, Hans-Joachim, Goebel, Ulrich, Stoll, Sandra Emily, Kindgen-Milles, Detlef, Dubler, Simon, Fuest, Kristina, Schuster, Michael, Papadogoulas, Antonios, Mulita, Francesk, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Andrianopoulos, Ioannis, Groenendijk, Martijn, Evers, Mirjam, van Lelyveld-Haas, Lenneke, Meynaar, Iwan, Cornet, Alexander Daniel, Zegers, Marieke, Dieperink, Willem, Dormans, Tom, Hahn, Michael, Sjøbøe, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Romundstad, Luis, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Klimkiewicz, Jakub, Solek-pastuszka, Joanna, Onichimowski, Dariusz, Czuczwar, Miroslaw, Gawda, Ryszard, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Oliveira, Ana Isabel Pinho, Assis, Rui, de Lurdes Campos Santos, Maria, Santos, Henrique, Cardoso, Filipe Sousa, Gordinho, André, Banzo, Maria José Arche, Zalba-Etayo, Begoña, Cubero, Patricia Patricia, Priego, Jesús, Gomà, Gemma, Tomasa-Irriguible, Teresa Maria, Sancho, Susana, Ferreira, Aida Fernández, Vázquez, Eric Mayor, Mira, Ángela Prado, Ibarz, Mercedes, Iglesias, David, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, Aldecoa, Cesar, Perez-Torres, David, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, de Gopegui, Pablo Ruiz, Ben-Hamouda, Nawfel, Roberti, Andrea, Fleury, Yvan, Abidi, Nour, Chau, Ivan, Dullenkopf, Alexander, Pugh, Richard, Smuts, Sara, COVIP study group, [missing], Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), COVIP study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Balleby, I.R., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., 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, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Groenendijk, M., Evers, M., van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D.W., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., 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, F.S., Gordinho, A., Banzo, MJA, Zalba-Etayo, B., Cubero, P.P., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., 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, P.R., Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Pugh, R., and Smuts, S.

Subjects
IMPACT, MORTALITY, ICU, Medicine and Health Sciences, ILL ELDERLY-PATIENTS, 610 Medicine & health, ddc:610, Critical Care and Intensive Care Medicine, 610 Medizin und Gesundheit, FRAILTY, human activities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Open Access funding enabled and organized by Projekt DEAL. This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Bruno et al. Annals of Intensive Care (2022) 12:26 Page 10 of 11 The support of the study in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union’s Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Collaborative Research Center SFB 1116 (German Research Foundation, DFG) and by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf and No. 2020–21 to RRB for a Clinician Scientist Track. No (industry) sponsorship has been received for this investigator-initiated study. 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

Published
2022
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24. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author

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, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H. Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, COVIP study group, Flaatten, H., Wernly, B., Artigas, A., Beil, M., Sviri, S., van Heerden, P.V., Szczeklik, W., Elhadi, M., Zafeiridis, T., Moreno, R., Cecconi, M., Boumendil, A., Abosheaishaa, H.M., Abualqumboz, EMY, Ahmed, A.K., Ahmed, H., Aidoni, Z., Aldecoa, C., Alexandru, N., Ali, YKNM, Al-Sadawi, M., Andersen, K., Andersen, F.H., Assis, R., Azab, M.A., Azzam, A.Y., Badawy, M.R., Balleby, I.R., Barth, E., Ben-HAmouda, N., Besch, G., Besset, S., Bjerregaard, A.T., Brix, H., Bruno, R.R., Brushoej, J., Bundgaard, H., Burtin, P., Caillard, A., Canas-Perez, I., Charron, C., Chrisanthopoulou, E., Comellini, V., Cornet, A., Cubero, P.J., Czuczwar, M., Dauger, S., Diaz-Rodriguez, C., Dieperink, W., Dindane, Z., Djibré, M., Dormans, T., Dullenkopf, A., Dumas, G., Elgazzar, Y.A., Eller, P., Elsaka, A., Evers, M., Faltlhauser, A., Ferreira, A.F., Fjølner, J., Fleury, Y., Galbois, A., Garcon, P., Garnier, M., Gawda, R., Ghannam, A., Goebel, U., Gomà, G., Goncalves, B., Gordinho, A., Groenendijk, M., Guerot, E., Guidet, B., Gurjar, M., Haake, H., Haas, L., Habib, A.A., Hahn, M., Hansen, M.A., Hilles, MMY, Hussein, AARM, Iglesias, D., Joannidis, M., Jung, C., Jurcisin, I., Kabitz, H.J., Kelm, M., Kindgen-Milles, D., Klimkiewicz, J., Kuhn, K.F., Kunstein, A., Kurt, M., De Lange, D.W., Leaver, S., Lutz, M., Mahmoodpoor, A., Maizel, J., Marin, N., Marsh, B., Megarbane, B., Mesotten, D., Meybohm, P., Meyer, C., Mira, A.P., Namendys-Silva, S.A., Nedergaard, H.K., Nseir, S., Oeyen, S., Olasveengen, T., Oliveira, AIP, Oziel, J., Papadogoulas, A., Perez-Torres, D., Bollen Pinto, B., Piton, G., Plantefeve, G., Poerner, T., Priego, J., Rabha, A., Randerath, W., Raphaelen, J.H., Reper, P., Rigaud, J.P., Rivera, S.A., Roberti, A., Romundstad, L., Rovina, N., Salah, R., Saleh, M., Sancho, S., de Lurdes Campos Santos, M., Santos, H., Schaller, S., Schefold, J.C., Schuster, M., Shala, G., Sjøbø, B., Steiner, S., Strietzel, H.F., Swinnen, W., Tamayo-Lomas, L., Tharwat, S., Tomasa, T., Uhrenholt, S., Vaissiere, M., Valent, A., Valette, X., Vanderlinden, T., Vázquez, E.M., Villamayor, M.I., Villefrance, M., Voigt, I., Wassim, K., Welte, M., Wolff, G., Wollborn, J., Zalba-Etayo, B., Zegers, M., and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Male, Aged, 80 and over, Pandemia, COVID-19/mortality, Frailty, Critical Care, Frail Elderly/statistics & numerical data, COVID-19, 610 Medicine & health, Prognosis, Survival Analysis, Elderly, Frailty/mortality, Humans, Female, Prospective Studies, Outcome, Aged, COVID-19/therapy
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 multi-centre 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 (CFS). 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 (pConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

Published
2021
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25. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19 : results from an international observational study of 2860 patients

Author

Raphael Romano Bruno, Bernhard Wernly, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Stephan Binnebössel, Philipp Heinrich Baldia, Malte Kelm, Michael Beil, Sivri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Jakob Wollborn, Maria José Arche Banzo, Kristina Fuest, Brian Marsh, Finn H. Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Christian Jung, the COVIP Study Group, COVIP Study Group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Chapeta, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Johnsen, T.K., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Collins, A., Aujayeb, A., Leaver, S., Khaliq, W., Habib, A.A., Azab, M.A., Wassim, K., Elgazzar, Y.A., Salah, R., Abosheaishaa, H.M., Hussein Mohamed, AAR, Azzam, A.Y., Tharwat, S., Ali, YKNM, Elmandouh, O., Galal, I., Abu-Elfatth, A., Motawea, K., Elbahnasawy, M., Shehata, M., Tayeb, M., Osman, N., Abdel-Elsalam, W., Hussein, A.M., Aldhalia, A., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Mentec, H., Vanderlinden, T., Jurcisin, I., Megarbane, B., Chousterman, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Gurjar, M., Mahmoodpoor, A., Hussein, R., Al-Juaifari, M.A., Karantenachy, AKA, Sviri, S., Elsaka, A., Marsh, B., Comellini, V., Al-Ali, F., Almani, S., Khamees, A.A., Al-Shami, K., El Din, I.S., Abubaker, T., Ahmed, H., Rabha, A., Alhadi, A., Emhamed, M., Abdeewi, S., Abusalama, A., Huwaysh, M., Alghati, E.A., Ghannam, A., Namendys-Sylva, S.A., Groenendijk, M., Evers, M., Van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Massoud, JGG, Khan, A.G., Al-Qasrawi, S., Amro, S., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., 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, F.S., Gordinho, A., Grintescu, I.M., Tomescu, D., Badawy, M.R., José Arche Banzo, M., Zalba-Etayo, B., Cubero, P.J., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., 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, P.R., Saleh, M., Hilles, MMY, Abualqumboz, EMY, Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Chaaban, M.K., Shebani, M.M., Hmaideh, A., Shaher, A., Sahin, A.S., Saracoglu, K.T., Al-Sadawi, M., Pugh, R., Smuts, S., and Al-Saban, RAM

Subjects
SEPSIS, RC86-88.9, IMPACT, Research, SEPTIC SHOCK, LEVEL, Medicine and Health Sciences, Medical emergencies. Critical care. Intensive care. First aid, 610 Medicine & health, ELDERLY-PATIENTS, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
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

Published
2021
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26. The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years.

Author

de Lange DW, Soliman IW, Leaver S, Boumendil A, Haas LEM, Watson X, Boulanger C, Szczeklik W, Artigas A, Morandi A, Andersen F, Jung C, Moreno R, Walther S, Oeyen S, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Guidet B, and Flaatten H

Abstract

Background: Premorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival., Methods: Prospective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS)., Results: Overall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3-6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81-86) than patients dying within the first 6 months (median age 84, IQR 82-87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5-6 versus 6 points, IQR 3-6, p < 0.01)., Conclusions: We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making., Clinicaltrials: gov: NCT03370692., (© 2024. The Author(s).)

Published
2024
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27. 30-Day Mortality among Very Old Patients Admitted to European Intensive Care Units for Major Trauma.

Author

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, and Leaver SK

Subjects
Humans, Male, Female, Aged, 80 and over, Europe epidemiology, Hospital Mortality, Frailty mortality, Intensive Care Units, Wounds and Injuries mortality, Organ Dysfunction Scores
Abstract

Introduction: Cases of major trauma in the very old (over 80 years) are increasingly common in the intensive care unit (ICU). 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 by the use of organ dysfunction scores of both acute conditions (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 very elderly intensive care patient (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 multivariable regression analyses were undertaken to determine associations between CFS and SOFA score in the first 24 h, type of major trauma, and outcomes., Results: Of the 8,062 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 for 30 days was 54%. Median and interquartile range of CFS were the same for survivors and non-survivors. In the logistic regression analysis, CFS was not associated with increased mortality. SOFA score (p &lt; 0.001) and trauma with head injury (p &lt; 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., (© 2024 S. Karger AG, Basel.)

Published
2024
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28. Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study.

Author

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, and Joannidis M

Subjects
Humans, Aged, Aged, 80 and over, Prospective Studies, SARS-CoV-2, Critical Illness, Intensive Care Units, COVID-19, Diabetes Mellitus epidemiology
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., (© 2023. The Author(s).)

Published
2023
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29. 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.

Author

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, and Szczeklik W

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., (© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).)

Published
2023
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30. In reply: Sex-specific outcomes in COVID-19: missing pieces of the puzzle.

Author

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, and Jung C

Subjects
Male, Female, Humans, SARS-CoV-2, COVID-19
Published
2023
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31. The clinical frailty scale - does it predict outcome of the very-old in UK ICUs?

Author

Lonsdale DO, Tong L, Farrah H, Farnell-Ward S, Ryan C, Watson X, Cecconi M, Flaatten H, Fjølner J, Jung C, Guidet B, de Lange D, Szczeklik W, Muessig JM, and Leaver SK

Abstract

Introduction: The age of patients admitted into critical care in the UK is increasing. Clinical decisions for very-old patients, usually defined as over 80, can be challenging. Clinicians are frequently asked to predict outcomes as part of discussions around the pros and cons of an intensive care unit (ICU) admission. Measures of overall health in old age, such as the clinical frailty scale (CFS), are increasingly used to help guide these discussions. We aimed to understand the characteristics of the very-old critically unwell population in the UK and the associations between frailty and outcome of an ICU admission in our healthcare system (National Health Service, NHS)., Methods: Baseline characteristics, ICU interventions and outcomes (ICU- and 30-day mortality) were recorded for sequential admissions of very old patients to UK ICUs as part of the European VIP 1 and 2 studies. Patient characteristics, interventions and outcome measures were compared by frailty group using standard statistical tests. Multivariable logistic regression modelling was undertaken to test association between baseline characteristics, admission type and outcome., Results: 1858 participants were enrolled from 95 ICUs in the UK. The median age was 83. The median CFS was 4 (IQR 3-5). 30-day survival was significantly lower in the frail group (CFS > 4, 58%) compared to vulnerable (CFS = 4, 65%) and fit (CFS < 4 68%, p = .004). Sequential organ failure assessment (SOFA) score, reason for admission and CFS were all independently associated with increased 30-day mortality ( p < .01)., Conclusion: In the UK, frailty is associated with an increase in mortality at 30-days following an ICU admission. At moderate frailty (CFS 5-6), three out of every five patients admitted survived to 30-days. This is a similar mortality to septic shock., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Intensive Care Society 2022.)

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2023
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32. PrehospitaL Ultrasound in Undifferentiated DyspnEa (PreLUDE): a prospective, clinical, observational study.

Author

Gundersen EA, Juhl-Olsen P, Bach A, Rostgaard-Knudsen M, Nielsen BRR, Skaarup SH, Petersen HØ, Fjølner J, Poulsen MGG, and Bøtker MT

Subjects
Adult, Humans, Prospective Studies, Emergency Service, Hospital, Point-of-Care Systems, Dyspnea diagnostic imaging, Dyspnea etiology, Ultrasonography, Pulmonary Disease, Chronic Obstructive diagnosis, Asthma complications, Asthma diagnosis, Heart Failure complications, Heart Failure diagnostic imaging
Abstract

Background: Diagnostic uncertainty in patients with dyspnea is associated with worse outcomes. We hypothesized that prehospital point-of-care ultrasound (POCUS) can improve diagnostic accuracy., Methods: Prospective observational study of adult patients suffering dyspnea. Prehospital critical care physicians registered a suspected diagnosis based on clinical examination alone, performed POCUS of the heart and lungs, and finally registered suspected diagnoses based on their clinical examination supplemented with POCUS. Pre- and post-POCUS diagnoses were compared to endpoint committee adjudicated diagnoses. The primary outcome was improved sensitivity for diagnosing acute heart failure. Secondary outcomes included other diagnostic accuracy measures in relation to acute heart failure and other causes of dyspnea., Results: In total, 214 patients were included. The diagnosis of acute heart failure was suspected in 64/214 (30%) of patients before POCUS and 64/214 (30%) patients after POCUS, but POCUS led to reclassification in 53/214 (25%) patients. The endpoint committee adjudicated the diagnosis of acute heart failure in 87/214 (41%) patients. The sensitivity for the diagnosis of acute heart failure was 58% (95% CI 46%-69%) before POCUS compared to 65% (95% CI 53%-75%) after POCUS (p = 0.12). ROC AUC for the diagnosis acute heart failure was 0.72 (95% CI 0.66-0.78) before POCUS compared to 0.79 (0.73-0.84) after POCUS (p < 0.001). ROC AUC for the diagnosis acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) or asthma was 0.87 (0.82-0.91) before POCUS and 0.93 (0.88-0.97) after POCUS (p < 0.001). A POCUS finding of any of severely reduced left ventricular function, bilateral B-lines or bilateral pleural effusion demonstrated the highest sensitivity for acute heart failure at 88% (95% CI 79%-94%), whereas the combination of all of these three findings yielded the highest specificity at 99% (95% CI 95%-100%)., Conclusion: Supplementary prehospital POCUS leads to an improvement of diagnostic accuracy of both heart failure and AE-COPD/-asthma overall described by ROC AUC, but the increase in sensitivity for the diagnoses of acute heart failure did not reach statistical significance. Tailored use of POCUS findings optimizes diagnostic accuracy for rule-out and rule-in of acute heart failure., Trial Registration: Registered in Clinical Trials, 05.04.2019 (identifier: NCT03905460) https://clinicaltrials.gov/ct2/show/study/NCT03905460?term=NCT03905460&cond=Dyspnea&cntry=DK&draw=2&rank=1 ., (© 2023. The Author(s).)

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2023
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33. Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study.

Author

Erkens R, Duse D, Wernly B, Flaatten H, Fjølner J, Bruno RR, Wolff G, Artigas A, Kelm M, Beil M, Sviri S, Schaller SJ, Fuest K, Szczeklik W, Piayda K, Elhadi M, Joannidis M, Nedergaard HK, Oeyen S, Moreno R, Leaver S, de Lange DW, Guidet B, and Jung C

Subjects
Humans, Aged, Critical Illness, Prospective Studies, Blood Transfusion, Hemoglobins, COVID-19 complications, COVID-19 therapy, Anemia therapy
Abstract

Aims: Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients., Methods: In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded., Results: In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality., Conclusion: The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.

Published
2023
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34. Cytokine absorption in critically ill old COVID-19 patients with renal failure: A retrospective analysis of 503 intensive care unit patients.

Author

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, and Jung C

Subjects
Humans, Retrospective Studies, Prospective Studies, Cytokines, Critical Illness, Intensive Care Units, COVID-19, Acute Kidney Injury
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.

Published
2023
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35. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial.

Author

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, and Jung C

Subjects
Humans, Acetaminophen therapeutic use, Prospective Studies, Critical Illness, Pandemics, Critical Care methods, COVID-19
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., (© 2022. The Author(s).)

Published
2022
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36. COVID-19 machine learning model predicts outcomes in older patients from various European countries, between pandemic waves, and in a cohort of Asian, African, and American patients.

Author

Mamandipoor B, Bruno RR, Wernly B, Wolff G, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Sigal S, Leaver S, De Lange DW, Guidet B, Flaatten H, Szczeklik W, Jung C, and Osmani V

Abstract

Background: COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical decision making. In this regard, machine learning methods have been shown to enhance prognostication, while improving consistency. However, current machine learning approaches have been limited by lack of generalisation to diverse patient populations, between patients admitted at different waves and small sample sizes., Objectives: We sought to investigate whether machine learning models, derived on routinely collected clinical data, can generalise well i) between European countries, ii) between European patients admitted at different COVID-19 waves, and iii) between geographically diverse patients, namely whether a model derived on the European patient cohort can be used to predict outcomes of patients admitted to Asian, African and American ICUs., Methods: We compare Logistic Regression, Feed Forward Neural Network and XGBoost algorithms to analyse data from 3,933 older patients with a confirmed COVID-19 diagnosis in predicting three outcomes, namely: ICU mortality, 30-day mortality and patients at low risk of deterioration. The patients were admitted to ICUs located in 37 countries, between January 11, 2020, and April 27, 2021., Results: The XGBoost model derived on the European cohort and externally validated in cohorts of Asian, African, and American patients, achieved AUC of 0.89 (95% CI 0.89-0.89) in predicting ICU mortality, AUC of 0.86 (95% CI 0.86-0.86) for 30-day mortality prediction and AUC of 0.86 (95% CI 0.86-0.86) in predicting low-risk patients. Similar AUC performance was achieved also when predicting outcomes between European countries and between pandemic waves, while the models showed high calibration quality. Furthermore, saliency analysis showed that FiO2 values of up to 40% do not appear to increase the predicted risk of ICU and 30-day mortality, while PaO2 values of 75 mmHg or lower are associated with a sharp increase in the predicted risk of ICU and 30-day mortality. Lastly, increase in SOFA scores also increase the predicted risk, but only up to a value of 8. Beyond these scores the predicted risk remains consistently high., Conclusion: The models captured both the dynamic course of the disease as well as similarities and differences between the diverse patient cohorts, enabling prediction of disease severity, identification of low-risk patients and potentially supporting effective planning of essential clinical resources., Trial Registration Number: NCT04321265., Competing Interests: JCS report grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Phagenesis, and Nycomed outside the submitted work. The money was paid into departmental funds. No personal financial gain applied. The other authors declare no Competing Financial or Non-Financial Interests., (Copyright: © 2022 Mamandipoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2022
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37. The effects of preoperative focused cardiac ultrasound in high-risk patients: A randomised controlled trial (PREOPFOCUS).

Author

Pallesen J, Bhavsar R, Fjølner J, Bakke SA, Krog J, Andersen MAS, Bøndergaard MH, Jessing TD, Mortensen L, Nielsen MB, Vang M, Malachauskiené L, and Juhl-Olsen P

Subjects
Humans, Length of Stay, Hospitalization, Heart, Ultrasonography, COVID-19
Abstract

Background: Surgery is the third most common cause of mortality worldwide. Focused cardiac ultrasound (FOCUS) yields information on cardiac status and discloses the presence of unknown pathology. Preoperative FOCUS changes patient treatment, allowing for a patient-tailored anaesthesia. We hypothesised that preoperative FOCUS would reduce the proportion of patients who were either admitted to hospital for more than 10 days or who were dead within 30 days after high-risk, non-cardiac surgery., Methods: This was a randomised, controlled, multi-center study. Patients ≥65 years of age, admitted for urgent orthopaedic- or abdominal surgery, scheduled for general- or neuraxial anaesthesia and with ASA 3/4 were eligible for inclusion. Patients were randomised in a 1:1 ratio to preoperative FOCUS or no preoperative FOCUS performed in accordance with a predefined protocol. Primary endpoint was the proportion of patients admitted more than 10 days or who were dead within 30 days. Secondary endpoints included major complications, days of admission and changes in anaesthesia handling., Results: During the second COVID-19 wave the study monitoring committee terminated the study prematurely. We included 338 patients of which 327 were included in the final analysis. In the FOCUS group, 41/163 (25%) patients met the criteria for the primary endpoint versus 35/164 (21%) for the control group, adjusted odds ratio 1.37 (95% CI 0.86-2.30), p = .36. The proportions of patients who developed major complications did not differ significantly between groups. Length of hospital stay was 4 (3-8) days in the FOCUS group and 4 (3-7) days on the control group (adjusted p = .24)., Conclusion: The routine availability of preoperative FOCUS assessment in this cohort does not appear to reduce the risk for hospitalisation exceeding 10 days or 30-day mortality, although study enrolment was prematurely terminated., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Published
2022
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38. Consent is a confounding factor in a prospective observational study of critically ill elderly patients.

Author

Flaatten H, Guidet B, Jung C, Boumendil A, Leaver S, Szczeklik W, Artigas A, Andersen F, Moreno R, Walther S, Oeyen S, Schefold JC, Marsh B, Joannidis M, Elhadi M, Nalapko Y, Fjølner J, and de Lange DW

Subjects
Humans, Aged, Aged, 80 and over, Prospective Studies, Intensive Care Units, Outcome Assessment, Health Care, Critical Illness, Organ Dysfunction Scores
Abstract

During analysis of a prospective multinational observation study of critically ill patients ≥80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requirement for consent at admission but with deferred consent in survivors. Group B: ICUs where some form of active consent at admission was necessary either from the patient or surrogates. Patients' characteristics, the severity of disease and outcome variables were compared. Totally 3098 patients were included from 21 countries. The median age was 84 years (IQR 81-87). England was not included because of changing criteria for consent during the study period. Group A (7 countries, 1200 patients), and group B (15 countries, 1898 patients) were comparable with age and gender distribution. Cognition was better preserved prior to admission in group B. Group A suffered from more organ dysfunction at admission compared to group B with Sequential Organ Failure Assessment score median 8 and 6 respectively. ICU survival was lower in group A, 66.2% compared to 78.4% in group B (p<0.001). We hence found profound effects on outcomes according to differences in obtaining consent for this study. It seems that the most severely ill elderly patients were less often recruited to the study in group B. Hence the outcome measured as survival was higher in this group. We therefore conclude that consent likely is an important confounding factor for outcome evaluation in international studies focusing on old patients., Competing Interests: Joerg C. Schefold declares that the Dept. of Intensive Care Medicine Bern has/ had research and/or development/consulting contracts with (full disclosure): Orion Corporation, Abbott Nutrition International, B. Braun Medical AG, CSEM SA, Edwards Lifesciences Services GmbH/SA, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, and Nestlé. Educational grants were received from Fresenius Kabi; GSK; MSD; Lilly; Baxter; Astellas; AstraZeneca; B. Braun Medical AG, CSL Behring, Maquet, Novartis, Covidien, Nycomed, Pierre Fabre Pharma (Roba Pharma); Pfizer, Orion Pharma. The money went into departmental funds. No personal financial gain applies. This does not alter our adherence to PLOS ONE policies on sharing data and materials All other authors do not have any conflict of interest to declare related to this manuscript.

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2022
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39. 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.

Author

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, and Jung C

Subjects
Humans, Retrospective Studies, Intensive Care Units, Delivery of Health Care, Insurance, Health, Critical Illness, COVID-19
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., (© 2022. The Author(s).)

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2022
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40. Time-dependent uncertainty of critical care transitions in very old patients - lessons for time-limited trials.

Author

Beil M, Flaatten H, Guidet B, Joskowicz L, Jung C, de Lange D, Leaver S, Fjølner J, Szczeklik W, Sviri S, and van Heerden PV

Subjects
Aged, 80 and over, Critical Care methods, Critical Illness therapy, Humans, Intensive Care Units, Uncertainty, Frailty, Patient Transfer
Abstract

Purpose: Prognostication for patients with critical conditions remains challenging, especially for very old individuals. Time-limited trials (TLT) are used to decrease prognostic uncertainty in the individual patient by monitoring the response to treatment over a pre-determined period of time. However, there are substantial difficulties with determining the length of that period. This study presents a probabilistic method to estimate a suitable duration of a TLT based on temporal profiles of uncertainty about critical care and outcome., Materials and Methods: The study included very old patients (age ≥ 80 years, n = 1209) from the VIP2 study cohort who were admitted to the ICU for between 2 and 14 days, with respiratory or circulatory support from day 1 and with either no limitations of life-sustaining treatment or a decision to withdraw that treatment, as well as with complete data. Multi-state modelling of critical care trajectories to obtain time-dependent probabilities for transitions between distinct levels of organ support and to outcome states. The extent of uncertainty is quantified by Shannon's entropy of probability distributions at discrete points in time., Results: We detected periods of enhanced prognostic uncertainty of up to 7 days after admission. The duration of these periods depends on patient characteristics at baseline (frailty, severity of critical illness) and the extent of organ support., Conclusion: Time-dependent patterns of uncertainty concerning the response to critical care can inform decisions about the duration of TLTs which may last up to a week in very old patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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2022
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41. Ten-year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study.

Author

Trier F, Fjølner J, Sørensen AH, Søndergaard R, Kirkegaard H, and Raaber N

Subjects
Adult, Denmark epidemiology, Humans, Injury Severity Score, Logistic Models, Retrospective Studies, Trauma Centers
Abstract

Background: Trauma causes significant economic and societal burdens, and the trauma patient population and their prognosis change over time. This study aims to analyze 10-year trends of trauma patients at a major trauma center in Central Denmark Region., Methods: Five thousand three hundred and sixty-six patients aged ≥16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at a major trauma center between January 1, 2010, and December 31, 2019, were included. An annual percent change with a 95% confidence interval was used to estimate trends in the mechanism of injuries. Multiple logistic regression with mortality as the outcome was adjusted for age, sex, and ISS. Admission year was used as continuous variable in logistic regressions., Results: The median age increased from 37 in 2010 to 49 in 2019, and the proportion of patients aged ≥65 doubled. The annual incidence of minor injuries (ISS 1-15) decreased from 181.3/10 5 inhabitants in 2010 to 112.7/10 5 in 2019. Severe injuries (ISS > 15) increased from 10.1/10 5 inhabitants in 2010 to 13.6/10 5 in 2019. The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression indicates lower 30-day mortality for all trauma patients over the study period when adjusting for age, sex, and ISS (odds ratio: 0.94, 95% CI: 0.90-0.99). The 30-day mortality for severely injured patients with ISS > 15 seems to decrease during the study period when adjusting for age, sex, and ISS (Odds ratio: 0.92, 95% CI: 0.87-0.97). Fall injuries increased by 4.1% annually (95% CI: 2.3%-6.1%)., Conclusions: Ten-year trends of trauma patients at a major trauma center show an increasing median age, injury severity, and number of fall injuries. The 30-day mortality of trauma patients decreased slightly for both minor injuries and severe injuries when adjusting for age, sex, and injury severity., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

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2022
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42. Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

Author

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, and Jung C

Subjects
Aged, Aged, 80 and over, Critical Illness epidemiology, Critical Illness therapy, Europe epidemiology, Humans, Intensive Care Units, Prospective Studies, COVID-19 epidemiology, COVID-19 therapy, Terminal Care
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., (© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

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2022
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43. Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID-19 pandemic.

Author

Fjølner J, Haaland ØA, Jung C, de Lange DW, Szczeklik W, Leaver S, Guidet B, Sviri S, Van Heerden PV, Beil M, Hartog CS, and Flaatten H

Subjects
Adult, Child, Critical Care, Female, Humans, Male, Pandemics, Surveys and Questionnaires, Triage, Ventilators, Mechanical, COVID-19
Abstract

Background: The COVID-19 pandemic has caused a shortage of intensive care resources. Intensivists' opinion of triage and ventilator allocation during the COVID-19 pandemic is not well described., Methods: This was a survey concerning patient numbers, bed capacity, triage guidelines, and three virtual cases involving ventilator allocations. Physicians from 400 ICUs in a research network were invited to participate. Preferences were assessed with a five-point Likert scale. Additionally, age, gender, work experience, geography, and religion were recorded., Results: Of 437 responders 31% were female. The mean age was 44.4 (SD 11.1) with a mean ICU experience of 13.7 (SD 10.5) years. Respondents were mostly European (88%). Sixty-six percent had triage guidelines available. Younger patients and caretakers of children were favoured for ventilator allocation although this was less clear if this involved withdrawal of the ventilator from another patient. Decisions did not differ with ICU experience, gender, religion, or guideline availability. Consultation of colleagues or an ethical committee decreased with age and male gender., Conclusion: Intensivists appeared to prioritise younger patients for ventilator allocation. The tendency to consult colleagues about triage decreased with age and male gender. Many found such tasks to be not purely medical and that authorities should assume responsibility for triage during resource scarcity., (© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

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2022
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44. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study.

Author

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, and Szczeklik W

Subjects
Aged, Cohort Studies, Female, Humans, Intensive Care Units, Male, Pandemics, Prospective Studies, Respiration, Artificial, COVID-19 therapy, Frailty, Noninvasive Ventilation adverse effects, Respiratory Insufficiency therapy
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 ., (© 2022. The Author(s).)

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2022
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45. Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study.

Author

Fronczek J, Flaatten H, Guidet B, Polok K, Andersen FH, Andrew BY, Artigas A, Beil M, Cecconi M, Christensen S, de Lange DW, Fjølner J, Górka J, Joannidis M, Jung C, Kusza K, Leaver S, Marsh B, Morandi A, Moreno R, Oeyen S, Owczuk R, Agvald-Öhman C, Pinto BB, Rhodes A, Schefold JC, Soliman IW, Valentin A, Walther S, Watson X, Zafeiridis T, and Szczeklik W

Subjects
Aged, Aged, 80 and over, Critical Illness, Hospital Mortality, Humans, Prospective Studies, Hospitalization, Intensive Care Units
Abstract

Background: Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients., Methods: Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs)., Results: Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97])., Conclusion: The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation., (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Published
2022
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47. Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19.

Author

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, and Jung C

Subjects
Chronic Disease, Critical Care, Critical Illness, Hospitalization, Humans, Prognosis, Prospective Studies, Stroke Volume, COVID-19 complications, COVID-19 epidemiology, Heart Failure complications, Heart Failure epidemiology
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., (© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

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2022
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48. Disease-Course Adapting Machine Learning Prognostication Models in Elderly Patients Critically Ill With COVID-19: Multicenter Cohort Study With External Validation.

Author

Jung C, Mamandipoor B, 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, De Lange DW, Guidet B, Flaatten H, and Osmani V

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., (©Christian Jung, Behrooz Mamandipoor, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sigal Sviri, Peter V van Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, Venet Osmani. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 31.03.2022.)

Published
2022
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49. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19.

Author

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, and Jung C

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., (© 2022. The Author(s).)

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2022
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50. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.

Author

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, and Szczeklik W

Subjects
Aged, Correlation of Data, Europe, Female, Humans, Intensive Care Units statistics & numerical data, Length of Stay, Male, Prospective Studies, Respiration, Artificial, Survival Rate trends, Time Factors, Treatment Outcome, COVID-19 mortality, COVID-19 therapy, Critical Care methods, Critical Care statistics & numerical data, Critical Illness mortality, Tracheostomy mortality, Tracheostomy statistics & numerical data
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., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

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2022
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