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Cumulative incidence of organ support and treatment limitations. a Combined mechanical ventilation (MV) and non-invasive ventilation. b Mechanical ventilation (MV). c Vasoactive drugs. d Non-invasive ventilation (NIV). e Treatment limitations. f Renal replacement therapy (RRT)

Cumulative incidence of organ support and treatment limitations. a Combined mechanical ventilation (MV) and non-invasive ventilation. b Mechanical ventilation (MV). c Vasoactive drugs. d Non-invasive ventilation (NIV). e Treatment limitations. f Renal replacement therapy (RRT)

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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 r...

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... in vulnerable and 6 days (IQR 3.0-13) in frail patients (p < 0.001). Table 2 shows models revealing the association between frailty and outcome even after controlling for comorbidities and disease severity and treatment strategies. Frailty was associated with increased use of treatment limitations and reduction in respiratory support as shown in Fig. 2 (cumulative incidences in Additional file 9). The use of treatment limitations was significantly higher in frail patients compared to fit patients and vulnerable patients (20-day cumulative incidence was 26% (95% CI 23-29) for fit patients, 40% (33-47) for vulnerable patients and 43% (95% CI 37-48) for frail patients (p < 0.001). The ...

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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...

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... 16 The geriatric concept of frailty is gaining interest in triage 17 and is associated with outcome 18,19 and is strongly associated with outcome in elderly COVID-19 patients. 20 According to most COVID-19 ethical guidelines, age must not be considered the primary reason for triage but remains a relevant factor when estimating long-term prognosis. 11 However, if relevant patient information and history is scarce, weight may be placed on age as a triage criterion as it is easily obtainable. ...
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Background: The COVID-19 pandemic has caused a shortage of intensive care resources. Intensivists' opinion of triage and ventilator allocation during the COVID-19 pandemic is not well described. Methods: This was a survey concerning patient numbers, bed capacity, triage guidelines, and three virtual cases involving ventilator allocations. Physicians from 400 ICUs in a research network were invited to participate. Preferences were assessed with a five-point Likert scale. Additionally, age, gender, work experience, geography, and religion were recorded. Results: Of 437 responders 31% were female. The mean age was 44.4 (SD 11.1) with a mean ICU experience of 13.7 (SD 10.5) years. Respondents were mostly European (88%). Sixty-six percent had triage guidelines available. Younger patients and caretakers of children were favoured for ventilator allocation although this was less clear if this involved withdrawal of the ventilator from another patient. Decisions did not differ with ICU experience, gender, religion, or guideline availability. Consultation of colleagues or an ethical committee decreased with age and male gender. Conclusion: Intensivists appeared to prioritise younger patients for ventilator allocation. The tendency to consult colleagues about triage decreased with age and male gender. Many found such tasks to be not purely medical and that authorities should assume responsibility for triage during resource scarcity.
... Participants included in this analysis were enrolled to one of two prospective observational studies of very old intensive care patients (VIP2 and COVIP) [13,14]. Participating critical care units recruited consecutive admissions of patients over 80 years during a 6-month period in 2018-19 (VIP 2) for non-COVID patients and patients over 70 years with proven SARS-CoV-2 infection from March 2020 to January 2021 (COVIP). ...
... This hypothesis is supported by data showing a lower percentage of frail patients among French COVID patients than in other European patients with COVID-19. The percentage of frail patients in the European COVIP study was 20% [14], while it was only 9.1% in the French COVID ICU study [26]. ...
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Purpose: 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.
... A single-center retrospective study from Italy of 105 patients observed that the frailty index was an independent predictor of both higher in-hospital mortality and lower proportions with ICU admission (56). A recent large prospective multinational study (Outcomes and Prognostic Factors in COVID-19) identified that frailty was independently associated with lower survival (57). Similarly, our individual patient data metaanalysis also observed that frailty was independently associated with hospital mortality among patients with COVID-19 admitted to ICU. ...
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Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019. Data sources: We contacted the corresponding authors of 16 eligible studies published between December 1, 2019, and February 28, 2021, reporting on patients with confirmed coronavirus disease 2019 admitted to ICU with a documented Clinical Frailty Scale. Study selection: Individual patient data were obtained from seven studies with documented Clinical Frailty Scale were included. We classified patients as nonfrail (Clinical Frailty Scale = 1-4) or frail (Clinical Frailty Scale = 5-8). Data extraction: We collected patient demographics, Clinical Frailty Scale score, ICU organ supports, and clinically relevant outcomes (ICU and hospital mortality, ICU and hospital length of stays, and discharge destination). The primary outcome was hospital mortality. Data synthesis: Of the 2,001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and Sequential Organ Failure Assessment score, Clinical Frailty Scale score greater than or equal to 4, use of mechanical ventilation, vasopressors, renal replacement therapy, and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in patients with frailty (65.2% vs 41.8%; p < 0.001), with adjusted mortality increasing with a rising Clinical Frailty Scale score beyond 3. Younger and nonfrail patients were more likely to receive mechanical ventilation. Patients with frailty spent less time on mechanical ventilation (median days [interquartile range], 9 [5-16] vs 11 d [6-18 d]; p = 0.012) and accounted for only 12.3% of total ICU bed days. Conclusions: Patients with frailty with coronavirus disease 2019 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with nonfrail patients. Patients with frailty receiving mechanical ventilation were at greater risk of death than patients without frailty.