Dataset Information

Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis.

ABSTRACT: Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.

Data sources

We contacted the corresponding authors of 16 eligible studies published between December 1, 2019, and February 28, 2021, reporting on patients with confirmed coronavirus disease 2019 admitted to ICU with a documented Clinical Frailty Scale.

Study selection

Individual patient data were obtained from seven studies with documented Clinical Frailty Scale were included. We classified patients as nonfrail (Clinical Frailty Scale = 1-4) or frail (Clinical Frailty Scale = 5-8).

Data extraction

We collected patient demographics, Clinical Frailty Scale score, ICU organ supports, and clinically relevant outcomes (ICU and hospital mortality, ICU and hospital length of stays, and discharge destination). The primary outcome was hospital mortality.

Data synthesis

Of the 2,001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and Sequential Organ Failure Assessment score, Clinical Frailty Scale score greater than or equal to 4, use of mechanical ventilation, vasopressors, renal replacement therapy, and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in patients with frailty (65.2% vs 41.8%; p < 0.001), with adjusted mortality increasing with a rising Clinical Frailty Scale score beyond 3. Younger and nonfrail patients were more likely to receive mechanical ventilation. Patients with frailty spent less time on mechanical ventilation (median days [interquartile range], 9 [5-16] vs 11 d [6-18 d]; p = 0.012) and accounted for only 12.3% of total ICU bed days.

Conclusions

Patients with frailty with coronavirus disease 2019 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with nonfrail patients. Patients with frailty receiving mechanical ventilation were at greater risk of death than patients without frailty.

SUBMITTER: Subramaniam A

PROVIDER: S-EPMC8769107 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis.

Subramaniam Ashwin A Anstey Christopher C Curtis J Randall JR Ashwin Sushma S Ponnapa Reddy Mallikarjuna M Aliberti Márlon Juliano Romero MJR Avelino-Silva Thiago Junqueira TJ Welch Carly C Koduri Gouri G Prowle John R JR Wan Yize I YI Laurent Michaël R MR Marengoni Alessandra A Lim Jun Pei JP Pilcher David D Shekar Kiran K

Critical care explorations 20220118 1

Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.<h4>Data sources</h4>We contacted the corresponding authors of 16 eligible studies published between December 1, 2019, and Februar ...[more]

PMID: 35072081

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Project description:ObjectivesIn many countries, large numbers of critically ill patients with coronavirus disease 2019 are admitted to the ICUs within a short period of time, overwhelming usual care capacities. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favorable outcome. The purpose of this study was to report our experience in terms of ICU organization and anticipation, as well as reporting patient characteristics, treatment, and outcomes.DesignA prospective observational study.SettingThe division of intensive care at the Geneva University Hospitals (Geneva, Switzerland).PatientsAll consecutive adult patients with acute respiratory failure due to coronavirus disease 2019 admitted in the ICU between March 9, 2020, and May 19, 2020, were enrolled. Patients' demographic data, comorbidities, laboratory values, treatments, and clinical outcomes were collected.InterventionsNone.Measurements and main resultsThe ICU was reorganized into cells of six to eight patients under the care of three physicians and five nurses. Its capacity increased from 30 to 110 beds, fully equipped and staffed, transforming the surgical intermediate care unit, the postoperative care facility, and operating theaters into ICUs. Surge capacity has always exceeded the number of patients hospitalized. Among 129 critically ill patients with severe acute hypoxemic respiratory failure, 96% required invasive mechanical ventilation. A total of 105 patients (81%) were discharged alive and 24 died, corresponding to a mortality of 19%. Patients who died were significantly older, with higher severity scores at admission, had higher levels of d-dimers, plasma creatinine, high-sensitive troponin T, C-reactive protein, and procalcitonin, and required more frequent prone sessions.ConclusionsA rapid increase in ICU bed capacity, including adequate equipment and staffing, allowed for a large number of critically ill coronavirus disease 2019 patients to be taken care of within a short period of time. Anticipation and preparedness ahead of the wave may account for the low mortality observed in our center. These results highlight the importance of resources management strategy in the context of the ongoing coronavirus disease 2019 pandemic.

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Project description:IntroductionAuto-intoxication represents a considerable number of Intensive care unit (ICU) admissions. Literature focusing on characteristics and outcomes of ICU-admitted auto-intoxicated patients is limited.ObjectivesWe aimed to identify the quantity of intensive care admissions attributable to auto-intoxication in a Belgian tertiary center, to examine characteristics and outcomes of these patients, and to assess the impact of the covid-19 pandemic on these variables.MethodsIn this retrospective cohort study, all patients admitted to the ICU of JESSA hospital, Hasselt, Belgium with a diagnosis of auto-intoxication between January 1st 2017 and December 31st 2022, were included in the study. We collected data on patient characteristics, comorbidities, type of intoxication and outcomes including the length of ICU and hospital stay and mortality.ResultsIn total, 342 patients were included in the dataset, covering 2.44% of all ICU admissions from January 1st 2017 to December 31st 2022. Although auto-intoxication occurred in all age-categories, the age group from 18 to 29 years old, showed the highest prevalence (24%). More woman (57.6%) than man (42.4%) were included in the study. Of all included patients, 21.6% had a history of previous suicide attempt and 36.5% of previous auto-intoxication. The most common substances ingested were sedatives (44.4%), illicit drugs (20.2%), analgesics (17.8%), and antidepressants (16.7%) whereas in 54.1% of the cases, a combination of substances was ingested. Type of intoxication was separated into four groups: suicide attempt, accidental, iatrogenic and recreational use with suicide attempt accounting for 71.3% of all auto-intoxications. The prevalence of ICU-admitted auto-intoxicated patients remained stable over the 5-year study period. An impact of the Covid-19 pandemic on this prevalence could not be established. Overall mortality was low with an ICU- and hospital mortality of 1.75% and 2.6% respectively. Total mortality at time of dataset closure, on the other hand, was 7.2%.ConclusionsThe impact of auto-intoxication on ICU resource utilization is relatively high and the risk of recidivism is substantial. ICU- and in-hospital mortality after auto-intoxication is low, although these patients have a substantial risk for death in years to come after hospital discharge.

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Dataset Information

Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis.

Data sources

Study selection

Data extraction

Data synthesis

Conclusions

Publications

Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis.

Similar Datasets

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