Browsing by Author "De Lange, D"
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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.
- A Comparison of Very Old Patients Admitted to Intensive Care Unit After Acute Versus Elective Surgery or InterventionPublication . Jung, C; Wernly, B; Muessig, J; Kelm, M; Boumendil, A; Morandi, A; Andersen, F; Artigas, A; Bertolini, G; Cecconi, M; Christensen, S; Faraldi, L; Fjølner, J; Lichtenauer, M; Bruno, R; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Pinto, B; Soliman, I; Szczeklik, W; Valentin, A; Watson, X; Zafeiridis, T; De Lange, D; Guidet, B; Flaatten, H; VIP1 Study GroupBackground: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.
- 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.
- Sex-Specific Outcome Disparities in Very Old Patients Admitted to Intensive Care Medicine: a Propensity Matched AnalysisPublication . Wernly, B; Romano Bruno, R; Kelm, M; Boumendil, A; Morandi, A; Andersen, F; Artigas, A; Finazzi, S; Cecconi, M; Christensen, S; Faraldi, L; Lichtenauer, M; Muessig, J; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Bollen Pinto, B; Soliman, I; Szczeklik, W; Niederseer, D; Valentin, A; Watson, X; Leaver, S; Boulanger, C; Walther, S; Schefold, J; Joannidis, M; Nalapko, Y; Elhadi, M; Fjølner, J; Zafeiridis, T; De Lange, D; Guidet, B; Flaatten, H; Jung, CFemale and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The primary endpoint was 30-day-mortality. Baseline characteristics, data on management and geriatric scores including frailty assessed by Clinical Frailty Scale (CFS) were documented. Two propensity scores (for being male) were obtained for consecutive matching, score 1 for baseline characteristics and score 2 for baseline characteristics and ICU management. Male VIPs were younger (83 ± 5 vs. 84 ± 5; p < 0.001), less often frail (CFS > 4; 38% versus 49%; p < 0.001) but evidenced higher SOFA (7 ± 6 versus 6 ± 6 points; p < 0.001) scores. After propensity score matching, no differences in baseline characteristics could be observed. In the paired analysis, the mortality in male VIPs was higher (mean difference 3.34% 95%CI 0.92-5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03-1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04-1.27; p = 0.007) male sex was independently associated with higher odds for 30-day-mortality. Of note, male gender was not associated with ICU mortality (OR 1.08 95%CI 0.98-1.19; p = 0.14). Outcomes of elderly intensive care patients evidenced independent sex differences. Male sex was associated with adverse 30-day-mortality but not ICU-mortality. Further research to identify potential sex-specific risk factors after ICU discharge is warranted.Trial registration: NCT03134807 and NCT03370692; Registered on May 1, 2017 https://clinicaltrials.gov/ct2/show/NCT03370692 .
- 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.
- Withholding or Withdrawing of Life-Sustaining Therapy in Older Adults (≥ 80 years) Admitted to the Intensive Care UnitPublication . Guidet, B; Flaatten, H; Boumendil, A; Morandi, A; Andersen, FH; Artigas, A; Bertolini, G; Cecconi, M; Christensen, S; Faraldi, L; Fjølner, J; Jung, C; Marsh, B; Moreno, R; Oeyen, S; Öhman, C; Pinto, B; Soliman, I; Szczeklik, W; Valentin, A; Watson, X; Zafeiridis, T; De Lange, DPURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807).