Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID‐19 pneumonitis
Open Access
- 24 September 2022
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 71 (1), 145-156
- https://doi.org/10.1111/jgs.18044
Abstract
Background The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID-19 pneumonitis in those admitted to Australian and New Zealand ICUs. Methods This registry-based multicenter, retrospective cohort study included all frail adults (>= 16 years) with documented clinical frailty scale (CFS) scores, admitted to ICUs with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome (ARDS) over 2 years between January 01, 2020 and December 31, 2021. Frail patients (CFS >= 5) coded as having viral pneumonitis or ARDS due to COVID-19 were compared to those with other causes of viral pneumonitis or ARDS for documented treatment limitations. Results 884 frail patients were included in the final analysis from 129 public and private ICUs. 369 patients (41.7%) had confirmed COVID-19. There were more male patients in COVID-19 (55.3% vs 47.0%; p = 0.015). There were no differences in age or APACHE-III scores between the two groups. Overall, 36.0% (318/884) had treatment limitations, but similar between the two groups (35.8% [132/369] vs 36.1% [186/515]; p = 0.92). After adjusting for confounders, increasing frailty (OR = 1.72; 95%-CI 1.39-2.14), age (OR = 1.05; 95%-CI 1.04-1.06), and presence of chronic respiratory condition (OR = 1.58; 95%-CI 1.10-2.27) increased the likelihood of instituting treatment limitations. However, the presence of COVID-19 by itself did not influence treatment limitations (odds ratio [OR] = 1.39; 95%-CI 0.98-1.96). Conclusions The proportion of treatment limitations was similar in patients with frailty with or without COVID-19 pneumonitis at ICU admission.This publication has 40 references indexed in Scilit:
- Frailty in the face of COVID-19Age and Ageing, 2020
- ANZICS guiding principles for complex decision making during the COVID-19 pandemicCritical Care and Resuscitation, 2020
- Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in AustraliaBMJ Open, 2019
- Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort studyThe Medical Journal of Australia, 2019
- Limitation of Life‐Sustaining Care in the Critically Ill: A Systematic Review of the LiteratureJournal of Hospital Medicine, 2019
- Advance care planning in the context of clinical deterioration: a systematic review of the literaturePalliative Care: Research and Treatment, 2019
- Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysisJournal of the American Medical Directors Association, 2019
- The Relationship of Frailty and Hospitalization Among Older People: Evidence From a Meta‐AnalysisJournal of Nursing Scholarship, 2018
- Assessing frailty in the intensive care unit: A reliability and validity studyJournal of Critical Care, 2018
- Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admissionIntensive Care Medicine, 2006