We also collected modes of ventilation and oxygenation and complications over the ICU stay. The Clinical Frailty Scale is an ordinal hierarchical scale of 9 ranks, with a score of 1 being very fit, 2 well, 3 managing well, 4 vulnerable, 5 mildly frail, 6 moderately frail, 7 severely frail, 8 very severely frail, and 9 terminally ill. If the patient was not able to communicate, the physician obtained the information from the relatives. The Clinical Frailty Scale was collected upon ICU admission by the physician in charge of the patient during the medical examination. Baseline information collected at ICU admission were: age, sex, body mass index (BMI), active smoking, Simplified Acute Physiology Score (SAPS) II score, worse Sequential Organ Failure Assessment (SOFA) during the first 24 h, comorbidities, immunodeficiency (if present), Clinical Frailty Scale, the date of the first symptom, and dates of the hospital and ICU admissions. įull description of data collection is provided in the Additional file 1. Laboratory confirmation for SARS-Cov-2 was defined as a positive result of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay from either nasal or pharyngeal swabs, or lower respiratory tract aspirates. This manuscript follows the STROBE statement for reporting cohort studies.įor this analysis, we restricted the study population to patients who were 70 and above 70 years of age at the time of the admission to the participating ICU between February 25, 2020, and May 4, 2020, with laboratory-confirmed SARS-CoV-2 infection, and available Day-90 vital status. In case of refusal, the data were not collected accordingly. Patients and relatives had the possibility not to participate in the study. All patients or close relatives were informed that their medical data were anonymously included in the COVID-ICU cohort. It received approval from the ethical committee of the French Intensive Care Society (CE-SRLF 20-23) and Swiss and Belgium ethical committees following local regulations.
COVID-ICU was a multi-center, observational, and prospective cohort study conducted in 149 ICUs from 138 centers, across three countries (France, Switzerland, and Belgium) and has been described elsewhere. We performed an ancillary analysis of the COVID-ICU study. We sought to assess the characteristics, management, and prognosis of the patients over 70 years enrolled in the international COVID-ICU cohort. As the debate is still active whether the management of COVID-19 should differ from ARDS related to other causes, the specific ICU management and outcomes of the old patients with SARS-CoV-2 related ARDS has not been fully described so far. This result concurred with the dismal prognosis reported in previous studies focused on elderly patients with ARDS not related to SARS-CoV-2 infection. In a large German study enrolling 10,021 patients, 923 (9%) patients over 70 years old received ventilatory support which was associated with 63% in-hospital mortality in those 70–79 years. To date, few studies specifically reported the management and prognosis of the elderly patients in the context of SARS-CoV-2 lower respiratory tract infection, but none were focused on a population admitted in ICU. These data may serve policymakers to properly and fairly allocate health care resources to that population and also to provide transparent information to the patient and caregivers. Therefore, there is an urgent need to provide consistent data on the management and prognosis of the elderly patients in the intensive care unit (ICU). One of them is the decision to admit the oldest patients in the ICU, which should be guided by robust data on the outcomes of that population.
Given the heavy burden of ARDS-related SARS-CoV-2 infection in terms of health care resources and the worrisome prognosis of this disease, the pandemic has raised several ethical questions. Then, the case fatality rates observed in ARDS-related SARS-CoV-2 is close to 30–40%, but can reach 70% in the older patients. The prognosis of this disease widely varies between countries, the age of the patients, the characteristics of the population studied, and the severity of the ARDS.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a risk factor for acute respiratory distress syndrome (ARDS) that is currently a major healthcare challenge worldwide.
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