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The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study

(2021) CRITICAL CARE. 25(1).
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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: , registered 19 March 2020.
Keywords
Critical Care and Intensive Care Medicine, COVID-19, Frailty, Outcome, Elderly, Pandemia

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MLA
Jung, Christian, et al. “The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 : The COVIP Study.” CRITICAL CARE, vol. 25, no. 1, 2021, doi:10.1186/s13054-021-03551-3.
APA
Jung, C., COVIP study group, [missing], Flaatten, H., Fjølner, J., Bruno, R. R., Wernly, B., … Guidet, B. (2021). The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study. CRITICAL CARE, 25(1). https://doi.org/10.1186/s13054-021-03551-3
Chicago author-date
Jung, Christian, [missing] COVIP study group, Hans Flaatten, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, et al. 2021. “The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 : The COVIP Study.” CRITICAL CARE 25 (1). https://doi.org/10.1186/s13054-021-03551-3.
Chicago author-date (all authors)
Jung, Christian, [missing] COVIP study group, Hans Flaatten, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sigal Sviri, Peter Vernon van Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H. Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, and Bertrand Guidet. 2021. “The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 : The COVIP Study.” CRITICAL CARE 25 (1). doi:10.1186/s13054-021-03551-3.
Vancouver
1.
Jung C, COVIP study group [missing], Flaatten H, Fjølner J, Bruno RR, Wernly B, et al. The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study. CRITICAL CARE. 2021;25(1).
IEEE
[1]
C. Jung et al., “The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study,” CRITICAL CARE, vol. 25, no. 1, 2021.
@article{8707775,
  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: , registered 19 March 2020.}},
  articleno    = {{149}},
  author       = {{Jung, Christian and COVIP study group, [missing] and Flaatten, Hans and Fjølner, Jesper and Bruno, Raphael Romano and Wernly, Bernhard and Artigas, Antonio and Bollen Pinto, Bernardo and Schefold, Joerg C. and Wolff, Georg and Kelm, Malte and Beil, Michael and Sviri, Sigal and van Heerden, Peter Vernon and Szczeklik, Wojciech and Czuczwar, Miroslaw and Elhadi, Muhammed and Joannidis, Michael and Oeyen, Sandra and Zafeiridis, Tilemachos and Marsh, Brian and Andersen, Finn H. and Moreno, Rui and Cecconi, Maurizio and Leaver, Susannah and Boumendil, Ariane and De Lange, Dylan W. and Guidet, Bertrand}},
  issn         = {{1364-8535}},
  journal      = {{CRITICAL CARE}},
  keywords     = {{Critical Care and Intensive Care Medicine,COVID-19,Frailty,Outcome,Elderly,Pandemia}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{9}},
  title        = {{The impact of frailty on survival in elderly intensive care patients with COVID-19 : the COVIP study}},
  url          = {{http://dx.doi.org/10.1186/s13054-021-03551-3}},
  volume       = {{25}},
  year         = {{2021}},
}

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