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Outcomes of critically ill older adults with COVID-19: a multicentre retrospective cohort study

Devenirs des personnes âgées gravement malades atteintes de la COVID-19 : une étude de cohorte rétrospective multicentrique

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Abstract

Purpose

Older adults with COVID-19 have a high prevalence of complications and mortality during hospitalization. Given the large proportion of older adults requiring admission to an intensive care unit (ICU), we aimed to describe the management and outcomes of older adults with COVID-19 requiring ICU care and identify predictors of hospital mortality.

Methods

We included consecutive patients ≥ 65 yr of age who were admitted between 11 March 2020 and 30 June 2021 to one of five Toronto (ON, Canada) ICUs with a primary diagnosis of SARS-CoV-2 infection in a retrospective cohort study. Patient characteristics, ICU treatment, and outcomes were recorded. We used multivariable logistic regression to identify predictors of in-hospital mortality.

Results

Of the 273 patients, the median [interquartile range] age was 74 [69–80] yr, 104 (38.1%) were female, and 164 (60.1%) required invasive mechanical ventilation. One hundred and forty-two patients (52.0%) survived their hospital stay. Compared with survivors, nonsurvivors were older (74 [70–82] yr vs 73 [68–78] yr; P = 0.03), and a smaller proportion was female (39/131, 29.8% vs 65/142, 45.8%; P = 0.01). Patients had long hospital (19 [11–35] days) and ICU (9 [5–22] days) stays, with no significant differences in ICU length of stay or duration of invasive mechanical ventilation between the two groups. Higher APACHE II score, increasing age, and the need for organ support were independently associated with higher in-hospital mortality while female sex was associated with lower mortality.

Conclusions

Older critically ill COVID-19 patients had long ICU and hospital stays, and approximately half died in hospital. Further research is needed to identify individuals who will benefit most from an ICU admission and to evaluate posthospitalization outcomes.

Résumé

Objectif

Les personnes âgées atteintes de la COVID-19 ont une prévalence élevée de complications et de mortalité pendant l’hospitalisation. Compte tenu de la forte proportion de personnes âgées nécessitant une admission dans une unité de soins intensifs (USI), nous avons cherché à décrire la prise en charge et les devenirs des personnes âgées atteintes de COVID-19 nécessitant des soins intensifs et à identifier les prédicteurs de mortalité hospitalière.

Méthode

Nous avons inclus des patient·es consécutif·ves âgé·es de ≥ 65 ans admis·es entre le 11 mars 2020 et le 30 juin 2021 dans l’une des cinq unités de soins intensifs de Toronto (ON, Canada) avec un diagnostic primaire d’infection par le SRAS-CoV-2 dans une étude de cohorte rétrospective. Les caractéristiques des patient·es, le traitement en USI et les devenirs ont été enregistrés. Nous avons utilisé une régression logistique multivariable pour identifier les prédicteurs de mortalité hospitalière.

Résultats

Parmi les 273 patient·es, l’âge médian [écart interquartile] était de 74 [69-80] ans, 104 (38,1 %) étaient des femmes et 164 (60,1 %) ont nécessité une ventilation mécanique invasive. Cent quarante-deux personnes (52,0 %) ont survécu à leur séjour à l’hôpital. Comparativement aux personnes survivantes, les personnes qui n’ont pas survécu étaient plus âgées (74 [70-82] ans vs 73 [68–78] ans; P = 0,03), et une plus faible proportion était de sexe féminin (39/131, 29,8 % vs 65/142, 45,8 %; P = 0,01). Les séjours des patient·es à l’hôpital (19 [11-35] jours) et à l’USI (9 [5-22] jours) étaient longs, sans différence significative dans la durée du séjour en USI ou la durée de la ventilation mécanique invasive entre les deux groupes. Un score APACHE II plus élevé, un âge plus avancé et le besoin de mesures de soutien d’organes étaient indépendamment associés à une mortalité plus élevée à l’hôpital, tandis que le sexe féminin était associé à une mortalité plus faible.

Conclusion 

Les personnes plus âgées gravement malades atteintes de la COVID-19 ont eu de longs séjours en soins intensifs et à l’hôpital, et environ la moitié sont décédées à l’hôpital. D’autres recherches sont nécessaires pour identifier les personnes qui bénéficieraient le plus d’une admission à l’USI et pour évaluer les devenirs post-hospitalisation.

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Author contributions

Eric K. C. Wong, Jennifer Watt, Richard Norman, Katrina Piggott, Sharon E. Straus, Barbara Liu, and Sangeeta Mehta contributed to the study conception and design. Data collection was performed by Kiyan Heybati, Eric K. C. Wong, Hanyan Zou, Arthana Chandraraj, and Alissa W. Zhang. Data analysis was performed by Eric Kai-Chung Wong. The first draft of the manuscript was written by Kiyan Heybati, Eric K. C. Wong, and Sangeeta Mehta and all authors commented on previous versions of the manuscript.

Disclosures

None.

Funding statement

Academic Health Science Centre Alternate Funding Plans Innovative Funds from Unity Health Toronto; Sinai Health/University Health Network Healthy Ageing and Geriatrics Program and its Geriatrics Summer Scholars Program; Division of Geriatric Medicine and General Internal Medicine, Sunnybrook Health Sciences Centre. The sponsor has no role in this study’s design, method, patient recruitment, data collection, analysis, or the manuscript. SES is funded by a Tier 1 Canada Research Chair. EKW is funded by the Clinician Scientist Training Program at the University of Toronto and the Vanier Scholarship from the Canadian Institutes of Health Research.

Prior conference presentations

Dr. Heybati presented this research at the Critical Care Canada Forum (28 November–1 December 2022, Toronto, ON, Canada).

Editorial responsibility

This submission was handled by Dr. Alexis F. Turgeon, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

Author information

Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Kiyan Heybati BHSc

  2. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Eric K. C. Wong MD & Jennifer Watt MD, PhD

  3. Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Eric K. C. Wong MD, Jennifer Watt MD, PhD, Arthana Chandraraj BSc & Sharon E. Straus MD

  4. Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Eric K. C. Wong MD, Jennifer Watt MD, PhD, Sharon E. Straus MD & Barbara Liu MD

  5. Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, Canada

    Hanyan Zou BSc, Richard Norman MD & Katrina Piggott MD

  6. Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Alissa W. Zhang BSc & Barbara Liu MD

  7. Department of Medicine, Sinai Health System, 600 University Ave., Suite 18-216, Toronto, ON, M5G 1X5, Canada

    Sangeeta Mehta MD

  8. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Sangeeta Mehta MD

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  1. Kiyan Heybati BHSc
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Correspondence to Sangeeta Mehta MD.

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Supplementary Information

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12630_2023_2518_MOESM1_ESM.pdf

Supplementary file1 (PDF 705 KB)—eTable 1 STROBE checklist. eTable 2 Additional ventilatory interventions and parameters, stratified by hospital outcome. eFig. 1 Lowest PaO2/FIO2 ratio on ICU days 1 to 7. eFig. 2 Median tidal volume on ICU days 1 to 7. eFig. 3 Lowest arterial pH on ICU days 1 to 7. eFig. 4 Lowest arterial pH on ICU days 1 to 7. eFig. 5 Highest plateau pressure on ICU days 1 to 7. eFig. 6 Lowest mean arterial pressure on ICU days 1 to 7.

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Heybati, K., Wong, E.K.C., Watt, J. et al. Outcomes of critically ill older adults with COVID-19: a multicentre retrospective cohort study. Can J Anesth/J Can Anesth 70, 1371–1380 (2023). https://doi.org/10.1007/s12630-023-02518-y

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