Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU.
Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU.
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DOI：
10.1186/s13613-021-00861-1
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发表时间：
2021-05-14
影响因子：
8.1
通讯作者：
COVID-ICU investigators
中科院分区：
文献类型：
--
作者：
Dres M;Hajage D;Lebbah S;Kimmoun A;Pham T;Béduneau G;Combes A;Mercat A;Guidet B;Demoule A;Schmidt M;COVID-ICU investigators
COVID-19 大流行对医疗保健资源来说是一个沉重的负担。未来的决策政策需要关于入住重症监护病房 (ICU) 的老年 COVID-19 患者（>70 岁）的管理和预后的一致数据。从国际前瞻性 COVID-ICU 数据库中提取了危重老年患者（>70 岁）的特征、治疗和预后。倾向评分加权比较评估了入院时插管对第 90 天死亡率的影响。该分析包括 1199 名患者（占 COVID-ICU 队列的 28%）（中位[四分位]年龄 74[72-78]岁）。分别有 53%、31% 和 16% 的人年龄在 70-74 岁、75-79 岁和 80 岁以上。最常见的合并症是慢性高血压（62%）、糖尿病（30%）和慢性呼吸道疾病（25%）。临床虚弱量表中位数为 3 (2-3)。入院时，PaO2/FiO2 比率为 154 (105–222)。 740 名 (62%) 患者在第一天接受了插管，最终 938 名 (78%) 患者在 ICU 住院期间接受了插管。 193 名 80 岁以上患者的第 90 天总体死亡率为 46%，最高达到 67%。老年患者、糖尿病患者、入院时 PaO2/FiO2 比值较低、心血管功能障碍以及首次出现症状与入住 ICU 之间的时间间隔较短的患者死亡率较高。在倾向分析中，入住 ICU 时早期插管与显着较高的第 90 天死亡率相关（42% vs 28%；风险比 1.68；95% CI 1.24–2.27；p<0·001）。在第一波参与的 ICU 中，70 岁以上的患者占入院的 COVID-19 患者人数的四分之一以上。第 90 天死亡率为 46%，据报告，80 岁以上的患者或入 ICU 时插管的患者结局不佳。在线版本包含可在 10.1186/s13613-021-00861-1 获取的补充材料。
The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO2/FiO2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO2/FiO2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p < 0·001). Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission. The online version contains supplementary material available at 10.1186/s13613-021-00861-1.
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DOI：
10.1164/rccm.202006-2405oc
发表时间：
2021-01-01
影响因子：
24.7
作者：
Lim ZJ;Subramaniam A;Ponnapa Reddy M;Blecher G;Kadam U;Afroz A;Billah B;Ashwin S;Kubicki M;Bilotta F;Curtis JR;Rubulotta F
通讯作者：
Rubulotta F
影响因子：
2.9
作者：
Jiménez E;Fontán-Vela M;Valencia J;Fernandez-Jimenez I;Álvaro-Alonso EA;Izquierdo-García E;Lazaro Cebas A;Gallego Ruiz-Elvira E;Troya J;Tebar-Martinez AJ;Garcia-Marina B;Peña-Lillo G;Abad-Motos A;Macaya L;Ryan P;Pérez-Butragueño M;COVID@HUIL Working Group;COVID@HUIL Working Group
通讯作者：
COVID@HUIL Working Group
影响因子：
15.1
作者：
Azoulay, Elie;Beloucif, Sadek;Le Dorze, Matthieu
通讯作者：
Le Dorze, Matthieu
影响因子：
38.9
作者：
Guidet, Bertrand;de Lange, Dylan W.;Flaatten, Hans
通讯作者：
Flaatten, Hans
影响因子：
8.8
作者：
Dennis JM;McGovern AP;Vollmer SJ;Mateen BA
通讯作者：
Mateen BA