Christian Jung1, Hans Flaatten2,3, Jesper Fjølner4, Raphael Romano Bruno5, Bernhard Wernly6, Antonio Artigas7, Bernardo Bollen Pinto8, Joerg C Schefold9, Georg Wolff5, Malte Kelm5, Michael Beil10, Sigal Sviri10, Peter Vernon van Heerden11, Wojciech Szczeklik12, Miroslaw Czuczwar13, Muhammed Elhadi14, Michael Joannidis15, Sandra Oeyen16, Tilemachos Zafeiridis17, Brian Marsh18, Finn H Andersen19,20, Rui Moreno21, Maurizio Cecconi22, Susannah Leaver23, Ariane Boumendil24,25, Dylan W De Lange26, Bertrand Guidet24,25. 1. Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de. 2. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 3. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. 4. Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. 6. Department of Cardiology, Paracelsus Medical University, Salzburg, Austria. 7. Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain. 8. Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland. 9. Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland. 10. Department of Medical Intensive Care, Hadassah University Medical Center, Jerusalem, Israel. 11. General Intensive Care Unit, Hadassah University Medical Center, Jerusalem, Israel. 12. Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland. 13. 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081, Lublin, Poland. 14. Faculty of Medicine, University of Tripoli, Tripoli, Libya. 15. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria. 16. Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium. 17. Intensive Care Unit General Hospital of Larissa, Larissa, Greece. 18. Mater Misericordiae University Hospital, Dublin, Ireland. 19. Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. 20. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. 21. Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal. 22. Department of Anaesthesia, IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy. 23. General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK. 24. Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France. 25. Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France. 26. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. METHODS: A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. RESULTS: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. CONCLUSION: Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
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-19patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. RESULTS: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. CONCLUSION: Frailty provides relevant prognostic information in elderly COVID-19patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
Authors: Tereza Prokopová; Jan Hudec; Kamil Vrbica; Jan Stašek; Andrea Pokorná; Petr Štourač; Kateřina Rusinová; Paulína Kerpnerová; Radka Štěpánová; Adam Svobodník; Jan Maláska Journal: Crit Care Date: 2022-07-19 Impact factor: 19.334
Authors: Bernhard Wernly; Hans Flaatten; Michael Beil; Jesper Fjølner; Raphael Romano Bruno; Antonio Artigas; Bernardo Bollen Pinto; Joerg C Schefold; Malte Kelm; Sviri Sigal; Peter Vernon van Heerden; Wojciech Szczeklik; Muhammed Elhadi; Michael Joannidis; Richard Rezar; Sandra Oeyen; Georg Wolff; Brian Marsh; Finn H Andersen; Rui Moreno; Sarah Wernly; Susannah Leaver; Ariane Boumendil; Dylan W De Lange; Bertrand Guidet; Stefan Perings; Christian Jung Journal: Sci Rep Date: 2022-10-19 Impact factor: 4.996
Authors: Raphael Romano Bruno; Bernhard Wernly; Behrooz Mamandipoor; Richard Rezar; Stephan Binnebössel; Philipp Heinrich Baldia; Georg Wolff; Malte Kelm; Bertrand Guidet; Dylan W De Lange; Daniel Dankl; Andreas Koköfer; Thomas Danninger; Wojciech Szczeklik; Sviri Sigal; Peter Vernon van Heerden; Michael Beil; Jesper Fjølner; Susannah Leaver; Hans Flaatten; Venet Osmani; Christian Jung Journal: Front Med (Lausanne) Date: 2021-07-09
Authors: Patrick Affeldt; Felix Carlo Koehler; Karl August Brensing; Vivien Adam; Julia Burian; Linus Butt; Martin Gies; Franziska Grundmann; Steffen Hinrichs; Wibke Johannis; Nils Kalisch; Matthias Meyer-Delpho; Simon Oehm; Eva Platen; Claudia Schöler; Eva Heger; Gertrud Steger; Dirk Stippel; Aileen Ziegelhöfer; Thomas Benzing; Florian Klein; Christine Kurschat; Roman-Ulrich Müller; Veronica Di Cristanziano Journal: Microorganisms Date: 2021-12-21