Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort

Abstract

Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.

Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients—The COVID-SOFA Score

“…In our cohort, demographic characteristics were similar to those of other study cohorts, non-survivors being older and having more comorbidities [17,18]. Regarding hematological changes induced by SARS-CoV-2, these were similar with previously reported data, with lymphopenia, neutrophilia and higher D-dimer values being associated with poor outcome [19,20].…”

“…In order to build the predictive model, after stepwise multivariate Cox PH regression was performed, the SOFA score independently predicted death together with age and NLR. Both age and NLR are considered to have independent predictive value for death [ 17 , 18 , 19 ], progression to severe or critical disease [ 19 , 30 ] and need for invasive mechanical ventilation [ 19 ] in COVID-19 patients. Moreover, given the fact that age and NLR have independent prognostic value in bacterial sepsis [ 31 , 32 ], we can speculate that this new score is reproducible in patients with COVID-19 and bacterial co-infection.…”

Clinical characteristics and factors associated with ICU mortality during the first year of the SARS-Cov-2 pandemic in Romania

“…In this cohort, 90% of patients who died had at least one comorbidity (Table 1), and almost 27% of patients were older than 75. A Romanian cohort, using the same prospective platform as the present study and reporting the outcomes of extremely elderly patients showed that 15% of the patients admitted to the ICUs with SARS-CoV-2 infections between March 2020 and December 2021 were older than 80 years and had a mortality of 78% 25 . The high proportion of elderly patients with SARS-CoV-2 infection admitted to the ICU and the high mortality in this group could partially explain the high mortality reported in this study.…”

“…Thirdly, there is a large proportion of elderly or extremely elderly patients in our cohort, a population in which several studies have pointed towards lack of benefit or even harm when prescribing corticosteroids. 25,33 Another factor influencing the effect of ICU treatments is that we did not collect and analyse data regarding the drugs administered prior to ICU admission.…”

The COVID-19 Vaccination Coverage in ICU Patients with Severe COVID-19 Infection in a Country with Low Vaccination Coverage—A National Retrospective Analysis

“…The overall mortality of ICU patients admitted with SARS-CoV-2 infection before vaccines were available was 62% [12]. Patients older than 80 years had higher mortality rates, especially if intubated [13].…”