Project

COVIP study - Corona Virus disease (COVID19) in Very Elderly Intensive care Patients (VIPs)

Goal: A European multicenter study of outcomes and prognostic factors in coronavirus disease (COVID-19) in very old intensive care patients.

The coronavirus SARS-CoV-2 is currently affecting thousands of patients across many countries and there is an urgent need to investigate patient characteristics and outcome trajectories.

The VIP network which has previously (2016-2019) conducted the most extensive prospective studies (VIP1, VIP2) on elderly ICU patients, is immediately deploying this study of elderly COVID19 patients.

See www.vipstudy.org for details and registration.

Date: 16 March 2020 - 1 January 2021

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Project log

Hans Flaatten
added 3 research items
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.
Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian ( > 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692 .
Hans Flaatten
added a research item
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.
Hans Flaatten
added an update
Our research group in the VIP project seized the opportunity to conduct a prospective study in COVID-19 ICU patients, mainly in Europe, with start March 2020. After collecting more than 3500 patients in this study we now enter the publication phase and we are proud to announce the acceptance of the first clinical study: The Impact of Frailty on Survival in Elderly Intensive Care Patients with COVID-19 – the COVIP Study in Critical Care. A pre-print version can be found here on Research Square (10.21203/rs.3.rs-245592/v1). The main and new finding we document in that study is that in the COVIP-19 critical ill patients the status of frailty is more important to understand mortality than age itself (above or less than 75 years), confirming that frailty is important as a pre-ICU factor.
Parallel to original (patients centered) studies we have also contributed to the discussion about triage (The good, the bad and the ugly: pandemic priority decisions and triage: 10.1136/medethics-2020-106489 ) and prognostication (Prognostication in older ICU patients: mission impossible?: 10.1016/j.bja.2020.08.005).
 
Christian Jung
added an update
The ongoing COVIP study (see www.vipstudy.org) included 1308 patients (by July 14th). A first interim analysis has been published and is uploaded to this project log. You are invited to read the first prospective data on previous ACE-inhibitor use in critically ill elderly Covid-19 patients.
 
Jesper Fjølner
added a project goal
A European multicenter study of outcomes and prognostic factors in coronavirus disease (COVID-19) in very old intensive care patients.
The coronavirus SARS-CoV-2 is currently affecting thousands of patients across many countries and there is an urgent need to investigate patient characteristics and outcome trajectories.
The VIP network which has previously (2016-2019) conducted the most extensive prospective studies (VIP1, VIP2) on elderly ICU patients, is immediately deploying this study of elderly COVID19 patients.
See www.vipstudy.org for details and registration.