Impact of Early Limitation of Therapeutic Effort in Elderly COVID-19 Patients Admitted to the Intensive Care Unit-A Cohort Study
(1) Background: Admission to the ICU and intensity of care provided to elderly COVID-19 patients are difficult choices guided by the expected patient-centered benefits. However, the impact of an early discussion of limitation of therapeutic effort (LTE) has been poorly investigated. (2) Methods: We performed a single-center retrospective cohort study including all ≥70-year-old COVID-19 patients admitted to the ICU. Factors associated with early LTE discussion (defined as before or up to 2 days post-ICU admission) and in-hospital mortality were evaluated. (3) Results: Eighty-two patients (59 M/23 F; 78 years (74−82) [median (interquartile range)]; 43/82 with LTE) were included. The in-hospital mortality rate was 55%. Early LTE was decided upon for 22/82 patients (27%), more frequently in older (p < 0.001) and frailer patients (p = 0.004). Using a multivariable logistic regression model including clinical frailty scale grade ≥4, hospital acquisition of COVID-19, ventilation support modality and SOFA score on admission, early LTE was not associated with mortality (adjusted odds ratio = 0.57 (0.15−2.00), p = 0.39). LTE resulted in less frequent invasive mechanical ventilation (23% versus 65%, p = 0.001), renal replacement therapy (5% versus 27%, p = 0.03) and norepinephrine infusion (23% versus 60%, p = 0.005), and shorter ICU stay (6 days (2−12) versus 14 days (7−24), p = 0.001). (4) Conclusions: In this small sample exploratory study, we were unable to demonstrate any increase in in-hospital mortality associated with early LTE discussion in elderly COVID-19 patients while reducing the use of organ support techniques. These findings require confirmation in larger studies.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2022 |
---|---|
Erschienen: |
2022 |
Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
---|---|
Enthalten in: |
Journal of personalized medicine - 12(2022), 9 vom: 14. Sept. |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Lacoste-Palasset, Thomas [VerfasserIn] |
---|
Links: |
---|
Themen: |
COVID-19 |
---|
Anmerkungen: |
Date Revised 08.03.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
---|
doi: |
10.3390/jpm12091501 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM346596580 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM346596580 | ||
003 | DE-627 | ||
005 | 20231226031832.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2022 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.3390/jpm12091501 |2 doi | |
028 | 5 | 2 | |a pubmed24n1155.xml |
035 | |a (DE-627)NLM346596580 | ||
035 | |a (NLM)36143286 | ||
035 | |a (PII)1501 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Lacoste-Palasset, Thomas |e verfasserin |4 aut | |
245 | 1 | 0 | |a Impact of Early Limitation of Therapeutic Effort in Elderly COVID-19 Patients Admitted to the Intensive Care Unit-A Cohort Study |
264 | 1 | |c 2022 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Revised 08.03.2023 | ||
500 | |a published: Electronic | ||
500 | |a Citation Status PubMed-not-MEDLINE | ||
520 | |a (1) Background: Admission to the ICU and intensity of care provided to elderly COVID-19 patients are difficult choices guided by the expected patient-centered benefits. However, the impact of an early discussion of limitation of therapeutic effort (LTE) has been poorly investigated. (2) Methods: We performed a single-center retrospective cohort study including all ≥70-year-old COVID-19 patients admitted to the ICU. Factors associated with early LTE discussion (defined as before or up to 2 days post-ICU admission) and in-hospital mortality were evaluated. (3) Results: Eighty-two patients (59 M/23 F; 78 years (74−82) [median (interquartile range)]; 43/82 with LTE) were included. The in-hospital mortality rate was 55%. Early LTE was decided upon for 22/82 patients (27%), more frequently in older (p < 0.001) and frailer patients (p = 0.004). Using a multivariable logistic regression model including clinical frailty scale grade ≥4, hospital acquisition of COVID-19, ventilation support modality and SOFA score on admission, early LTE was not associated with mortality (adjusted odds ratio = 0.57 (0.15−2.00), p = 0.39). LTE resulted in less frequent invasive mechanical ventilation (23% versus 65%, p = 0.001), renal replacement therapy (5% versus 27%, p = 0.03) and norepinephrine infusion (23% versus 60%, p = 0.005), and shorter ICU stay (6 days (2−12) versus 14 days (7−24), p = 0.001). (4) Conclusions: In this small sample exploratory study, we were unable to demonstrate any increase in in-hospital mortality associated with early LTE discussion in elderly COVID-19 patients while reducing the use of organ support techniques. These findings require confirmation in larger studies | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a COVID-19 | |
650 | 4 | |a death | |
650 | 4 | |a elderly | |
650 | 4 | |a frailty | |
650 | 4 | |a intensive care unit | |
650 | 4 | |a limitation of therapeutic effort | |
700 | 1 | |a Sutterlin, Laetitia |e verfasserin |4 aut | |
700 | 1 | |a M'Rad, Aymen |e verfasserin |4 aut | |
700 | 1 | |a Modestin, Louis |e verfasserin |4 aut | |
700 | 1 | |a Mourman, Vianney |e verfasserin |4 aut | |
700 | 1 | |a Pepin-Lehalleur, Adrien |e verfasserin |4 aut | |
700 | 1 | |a Malissin, Isabelle |e verfasserin |4 aut | |
700 | 1 | |a Naim, Giulia |e verfasserin |4 aut | |
700 | 1 | |a Grant, Caroline |e verfasserin |4 aut | |
700 | 1 | |a Guérin, Emmanuelle |e verfasserin |4 aut | |
700 | 1 | |a Ekhérian, Jean-Michel |e verfasserin |4 aut | |
700 | 1 | |a Deye, Nicolas |e verfasserin |4 aut | |
700 | 1 | |a Mégarbane, Bruno |e verfasserin |4 aut | |
700 | 1 | |a Voicu, Sebastian |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Journal of personalized medicine |d 2011 |g 12(2022), 9 vom: 14. Sept. |w (DE-627)NLM228113881 |x 2075-4426 |7 nnns |
773 | 1 | 8 | |g volume:12 |g year:2022 |g number:9 |g day:14 |g month:09 |
856 | 4 | 0 | |u http://dx.doi.org/10.3390/jpm12091501 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 12 |j 2022 |e 9 |b 14 |c 09 |