Risk factors associated with day-30 mortality in patients over 60 years old admitted in ICU for severe COVID-19: the Senior-COVID-Rea Multicentre Survey protocol

Abstract

IntroductionWith the spread of COVID-19 epidemic, health plans must be adapted continuously. There is an urgent need to define the best care courses of patients with COVID-19, especially in intensive care units (ICUs), according to their individualised benefit/risk ratio. Since older age is associated with poorer short-term and long-term outcomes, prediction models are needed, that may assist clinicians in their ICU admission decision. Senior-COVID-Rea was designed to evaluate, in patients over 60 years old admitted in ICU for severe COVID-19 disease, the impact of age and geriatric and paraclinical parameters on their mortality 30 days after ICU admission.Methods and analysisThis is a multicentre survey protocol to be conducted in seven hospitals of the Auvergne-Rhône-Alpes region, France. All patients over 60 years old admitted in ICU for severe COVID-19 infection (or their legally acceptable representative) will be proposed to enter the study and to fill in a questionnaire regarding their functional and nutritional parameters 1 month before COVID-19 infection. Paraclinical parameters at ICU admission will be collected: lymphocytes and neutrophils counts, high-fluorescent lymphoid cells and immature granulocytes percentages (Sysmex data), D-dimers, C-reactive protein, lactate dehydrogenase (LDH), creatinine, CT scan for lung extension rate as well as clinical resuscitation scores, and the delay between the first signs of infection and ICU admission. The primary outcome will be the overall survival at day 30 post-ICU admission. The analysis of factors predicting mortality at day 30 will be carried out using univariate and multivariate logistic regressions. Multivariate logistic regression will consider up to 15 factors.The ambition of this trial, which takes into account the different approaches of geriatric vulnerability, is to define the respective abilities of different operational criteria of frailty to predict patients’ outcomes.Ethics and disseminationThe study protocol was ethically approved. The results of the primary and secondary objectives will be published in peer-reviewed journals.Trial registration numberNCT04422340.

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

“…The COVIP study observed a mortality at 30 days (not general in-hospital mortality) of 41% in patients aged 70 or older, which increased to 48% at 90 days, and was 67% in frail patients [ 28 ]. Raw comparisons are difficult to make, as different age cut-offs are used in COVID-19-related articles: 60-years, 65-years, 70-years, 75-years, 80-years, and 85-years [ 4 , 10 , 19 , 21 , 25 , 28 , 29 , 30 , 31 ].…”

Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19

“…The primary objective was to evaluate the impact of age on 30-day mortality after ICU admission. A secondary objective was to construct a prognostic model for 30-day mortality based on co-morbidities, functional status of the patient 1 month before COVID-19 infection, laboratory data [ 8 , 9 , 26 ], radiological data [ 27 ], ICU parameters, and time since the first symptoms [ 25 ].…”

The impact of age on intensive care

“…A recent meta-analysis identified no increased mortality risk among frail patients after adjusting for age and other covariates ( Subramaniam et al, 2022 ). However, comparisons are not drawn easily between different COVID-19-related studies since various age cutoffs have been employed: 60 years, 65 years, 70 years, 75 years, 80 years, and 85 years ( Jung et al, 2021b , Demiselle et al, 2021 , Falandry et al, 2021 ). Due to the sheer pathophysiology of COVID-19, complications and rapid deterioration may arise acutely, especially in frail older individuals with reduced physiologic reserve capacity; hence, advanced directives are to be in place to accommodate patient wishes should they become incapacitated.…”