Age and Comorbidity Burden of Patients Critically Ill with COVID-19 Affect Both Access to and Outcome of Ventilation Therapy in Intensive Care Units.
Marie Louise de HesselleStefan BorgmannSiegbert RiegJörg Janne VehreschildSebastian RaschCarolin E M KollMartin HowerMelanie StecherDaniel EbertFrank HansesJulia Schumannnull On Behalf Of The Leoss Study GroupPublished in: Journal of clinical medicine (2023)
During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient's age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient's wishes.
Keyphrases
- sars cov
- end stage renal disease
- newly diagnosed
- intensive care unit
- ejection fraction
- mechanical ventilation
- prognostic factors
- peritoneal dialysis
- chronic kidney disease
- risk factors
- acute respiratory distress syndrome
- coronary artery disease
- type diabetes
- extracorporeal membrane oxygenation
- respiratory failure
- physical activity
- mesenchymal stem cells
- mass spectrometry
- cardiovascular disease
- big data
- minimally invasive
- community dwelling
- patient reported
- middle aged
- deep learning
- bone marrow
- body composition
- artificial intelligence
- replacement therapy