Browsing by Author "Beil, M"
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- Association of Chronic Heart Failure with Mortality in Old Intensive Care Patients Suffering from Covid‐19Publication . Romano Bruno, R; Wernly, B; Wolff, G; Fjølner, J; Artigas, A; Bollen Pinto, B; Schefold, J; Kindgen‐Milles, D; Baldia, P; Kelm, M; Beil, M; Sviri, S; Heerden, P; Szczeklik, W; Topeli, A; Elhadi, M; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, F; Moreno, R; Leaver, S; Boumendil, A; De Lange, D; Guidet, B; Flaatten, H; Jung, CAims: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. Methods and results: Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128). Conclusions: In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality.
- Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19Publication . Guidet, B; Jung, C; Flaatten, H; Fjølner, J; Artigas, A; Bollen Pinto, B; Schefold, J; Beil, M; Sigal, S; Vernon van Heerden, P; Szczeklik, W; Joannidis, M; Oeyen, S; Kondili, E; Marsh, B; Andersen, F; Moreno, R; Cecconi, M; Leaver, S; De Lange, D; Boumendil, A; Eller, P; Joannidis, M; Mesotten, D; Reper, P; Oeyen, S; Swinnen, W; Brix, H; Brushoej, J; Villefrance, M; Nedergaard, H; Bjerregaard, A; Balleby, I; Andersen, K; Hansen, M; Uhrenholt, S; Bundgaard, H; Fjølner, J; Hussein, A; Salah, R; Ali, Y; Wassim, K; Elgazzar, Y; Tharwat, S; Azzam, A; Habib, A; Abosheaishaa, H; Azab, M; Leaver, S; Galbois, A; Urbina, T; Charron, C; Guerot, E; Besch, G; Rigaud, JP; Maizel, J; Djibré, M; Burtin, P; Garcon, P; Nseir, S; Valette, X; Alexandru, N; Marin, N; Vaissiere, M; Plantefeve, G; Vanderlinden, T; Jurcisin, I; Megarbane, B; Caillard, A; Valent, A; Garnier, M; Besset, S; Oziel, J; Raphalen, J; Dauger, S; Dumas, G; Goncalves, B; Piton, G; Barth, E; Goebel, U; Barth, E; Kunstein, A; Schuster, M; Welte, M; Lutz, M; Meybohm, P; Steiner, S; Poerner, T; Haake, H; Schaller, S; Schaller, S; Schaller, S; Kindgen-Milles, D; Meyer, C; Kurt, M; Kuhn, K; Randerath, W; Wollborn, J; Dindane, Z; Kabitz, H; Voigt, I; Shala, G; Faltlhauser, A; Rovina, N; Aidoni, Z; Chrisanthopoulou, E; Papadogoulas, A; Gurjar, M; Mahmoodpoor, A; Ahmed, A; Marsh, B; Elsaka, A; Sviri, S; Comellini, V; Rabha, A; Ahmed, H; Namendys-Silva, S; Ghannam, A; Groenendijk, M; Zegers, M; de Lange, D; Cornet, A; Evers, M; Haas, L; Dormans, T; Dieperink, W; Romundstad, L; Sjøbø, B; Andersen, F; Strietzel, H; Olasveengen, T; Hahn, M; Czuczwar, M; Gawda, R; Klimkiewicz, J; Santos, ML; Gordinho, A; Santos, H; Assis, R; Oliveira, AI; Badawy, M; Perez-Torres, D; Gomà, G; Villamayor, M; Mira, A; Cubero, P; Rivera, S; Tomasa, T; Iglesias, D; Vázquez, E; Aldecoa, C; Ferreira, A; Zalba-Etayo, B; Canas-Perez, I; Tamayo-Lomas, L; Diaz-Rodriguez, C; Sancho, S; Priego, J; Abualqumboz, E; Hilles, M; Saleh, M; Ben-Hamouda, N; Roberti, A; Dullenkopf, A; Fleury, Y; Pinto, B; Schefold, J; Al-Sadaw, MPurpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.
- Prognosticating the Outcome of Intensive Care in Older Patients - a Narrative ReviewPublication . Beil, M; Moreno, R; Fronczek, J; Kogan, Y; Moreno, R; Flaatten, H; Guidet, B; de Lange, D; Leaver, S; Nachshon, A; van Heerden, P; Joskowicz, L; Sviri, S; Jung, C; Szczeklik, WPrognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment.
- The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19: the COVIP StudyPublication . Jung, C; Flaatten, H; Fjolner, J; Bruno, R; Wernly, B; Artigas, A; Pinto, B; Schefold, J; Wolff, G; Kelm, M; Beil, M; Sviri, S; Heerden, P; Szczeklil, W; Czuczwar, M; Elhadi, M; Joannidis, M; Oeyen, S; Zafeiridis, T; Marsh, B; Andersen, F; Moreno, R; Cecconi, M; Leaver, S; Boumendil, A; De Lange, D; Guidet, B; COVIP Study GroupBackground: 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: NCT04321265 , registered 19 March 2020.