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Browsing by Author "Wolff, G"

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  • Association of Chronic Heart Failure with Mortality in Old Intensive Care Patients Suffering from Covid‐19
    Publication . 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, C
    Aims: 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.
    2022Journal article Open access Show more
  • The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19: the COVIP Study
    Publication . 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 Group
    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: NCT04321265 , registered 19 March 2020.
    2021Journal article Open access Show more