Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe
Authors: Jung Christian , Fjølner Jesper , Bruno Raphael Romano , Wernly Bernhard , Artigas Antonio , Bollen Pinto Bernardo , Schefold Joerg C. , Wolff Georg , Kelm Malte , Beil Michael , Sviri Sigal , van Heerden Peter Vernon , Szczeklik Wojciech , Czuczwar Miroslaw , Joannidis Michael , Oeyen Sandra , Zafeiridis Tilemachos , Andersen Finn H. , Moreno Rui , Leaver Susannah , Boumendil Ariane , De Lange Dylan W. , Guidet Bertrand , Flaatten Hans ,   , COVIP Study Group, Eller Philipp , Joannidis Michael , Mesotten Dieter , Reper Pascal , Oeyen Sandra , Swinnen Walter , Brix Helene , Brushoej Jens , Villefrance Maja , Nedergaard Helene Korvenius , Bjerregaard Anders Thais , Balleby Ida Riise , Andersen Kasper , Hansen Maria Aagaard , Uhrenholt Stine , Bundgaard Helle , Fjølner Jesper , Mohamed Aliae AR Hussein , Salah Rehab , Ali Yasmin Khairy NasrEldin Mohamed , Wassim Kyrillos , Elgazzar Yumna A , Tharwat Samar , Azzam Ahmed Y , Habib Ayman abdelmawgoad , Abosheaishaa Hazem Maarouf , Azab Mohammed A , Leaver Susannah , Galbois Arnaud , Guidet Bertrand , Charron Cyril , Guerot Emmanuel , Besch Guillaume , Rigaud Jean-Philippe , Maizel Julien , Djibré Michel , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Alexandru Nica , Marin Nathalie , Vaissiere Marie , Plantefeve Gaëtan , Vanderlinden Thierry , Jurcisin Igor , Megarbane Buno , Caillard Anais , Valent Arnaud , Garnier Marc , Besset Sebastien , Oziel Johanna , Raphaelen Jean-herlé , Dauger Stéphane , Dumas Guillaume , Goncalves Bruno , Piton Gaël , Jung Christian , Bruno Raphael Romano , Kelm Malte , Wolff Georg , Barth Eberhard , Goebel Ulrich , Barth Eberhard , Kunstein Anselm , Schuster Michael , Welte Martin , Lutz Matthias , Meybohm Patrick , Steiner Stephan , Poerner Tudor , Haake Hendrik , Schaller Stefan , Kindgen-Milles Detlef , Meyer Christian , Kurt Muhammed , Kuhn Karl Friedrich , Randerath Winfried , Wollborn Jakob , Dindane Zouhir , Kabitz Hans-Joachim , Voigt Ingo , Shala Gonxhe , Faltlhauser Andreas , Rovina Nikoletta , Aidoni Zoi , Chrisanthopoulou Evangelia , Papadogoulas Antonios , Gurjar Mohan , Mahmoodpoor Ata , Ahmed Abdullah Khudhur , Marsh Brian , Elsaka Ahmed , Sviri Sigal , Comellini Vittoria , Rabha Ahmed , Ahmed Hazem , Namendys-Silva Silvio a , Ghannam Abdelilah , Groenendijk Martijn , Zegers Marieke , de Lange Dylan , Cornet Alex , Evers Mirjam , Haas Lenneke , Dormans Tom , Dieperink Willem , Romundstad Luis , Sjøbø Britt , Andersen Finn H , Strietzel Hans Frank , Olasveengen Theresa , Hahn Michael , Czuczwar Miroslaw , Gawda Ryszard , Klimkiewicz Jakub , de LurdesSantos Maria Campos , Gordinho André , Santos Henrique , Assis Rui , Oliveira Ana Isabel Pinho , Badawy Mohamed Raafat , Perez-Torres David , Gomà Gemma , Villamayor Mercedes Ibarz , Mira Angela Prado , Cubero Patricia Jimeno , Rivera Susana Arias , Tomasa Teresa , Iglesias David , Vázquez Eric Mayor , Aldecoa Cesar , Ferreira Aida Fernández , Zalba-Etayo Begoña , Canas-Perez Isabel , Tamayo-Lomas Luis , Diaz-Rodriguez Cristina , Sancho Susana , Priego Jesús , Abualqumboz Enas M.Y. , Hilles Momin Majed Yousuf , Saleh Mahmoud , Ben-HAmouda Nawfel , Roberti Andrea , Dullenkopf Alexander , Fleury Yvan , Pinto Bernardo Bollen , Schefold Joerg C , Al-Sadawi Mohammed , Serck Nicolas , Dewaele Elisabeth , Kumar Pritpal , Bundesen Camilla , Innes Richard , Gooch James , Cagova Lenka , Potter Elizabeth , Reay Michael , Davey Miriam , Humphreys Sally , Berlemont Caroline Hauw , Chousterman Benjamin Glenn , Dépret François , Ferre Alexis , Vettoretti Lucie , Thevenin Didier , Faltlhauser Andreas , Milovanovic Milena , Simon Philipp , Lorenz Marco , Stoll Sandra Emily , Dubler Simon , Fuest Kristina , Mulita Francesk , Kondili Eumorifa , Andrianopoulos Ioannis , Meynaar Iwan , Cornet Alexander Daniel , Sjøbøe Britt , Kluzik Anna , Zatorski Paweł , Drygalski Tomasz , Szczeklik Wojciech , Solek-pastuszka Joanna , Onichimowski Dariusz , Stefaniak Jan , Stefanska-Wronka Karina , Zabul Ewa , Cardoso Filipe Sousa , Banzo Maria José Arche , Tomasa-Irriguible Teresa Maria , Mira Ángela Prado , Arias-Rivera Susana , Frutos-Vivar Fernando , Lopez-Cuenca Sonia , de Gopegui Pablo Ruiz , Abidi Nour , Chau Ivan , Pugh Richard , Smuts Sara 
Published: April 2023

Abstract
Background
The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.

Methods
This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).

Results
In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).

Conclusion
An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.

Trial registration number

NCT04321265, registered March 19th, 2020.