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Senior-COVID-Rea Multicentre Observational Cohort Study: Development of a Geriatric Prediction Model of Day 30 Mortality in Patients Over 60 in ICU

34 Pages Posted: 6 Jan 2021

See all articles by Claire Falandry

Claire Falandry

Centre Hospitalier Universitaire Lyon Sud

Laurent Bitker

Independent

Paul Abraham

Independent

Fabien Subtil

Independent

Vincent Collange

Independent

Baptiste Balança

Independent

Max Haïne

Independent

Céline Guichon

Independent

Christophe Leroy

Independent

Marie Simon

Independent

Amélie Malapert

Independent

Mélanie Roche

Independent

Jean-Baptiste Pialat

Independent

Laurent Jallades

Independent

Alain Lepape

Independent

Arnaud Friggeri

Independent

Fabrice Thiolliere

Independent

Senior-COVID-Rea Study Group

More...

Abstract

Background: Current SARS-COV2 pandemic induces tensions on the health systems and ethical dilemmas. A triage tool is needed to define older patients with individual advantage to be considered for intensive care unit (ICU) transfer.

Methods: This multicentre observational cohort study included patients over 60 admitted into 7 ICUs between 7th March and 7th May 2020. The primary objective was to evaluate age impact on 30-day mortality, to construct a multivariate prognostic model. This analysis explores the prediction value of geriatric parameters 1 month before ICU admission. This trial is registered with ClinicalTrials.gov, number NCT04422340.

Findings: Among 290 screened patients, 231 were included in the cohort. In univariate analysis, factors associated with decreased day-30 survival were: age>75 (OR 4·82 [95%CI: 2·56-9·06]), three or more CIRS-G grade ≥2 comorbidities (OR 2·49 [95%CI: 1·36-4·56]), impaired ADL (Activities of Daily Living), (OR 4·86 [95%CI: 2·44-9·72]), impaired IADL8 (Instrumental ADL, 8 variables, OR 6·33 [95%CI: 3·31-12·10], p<0·001), frailty according Fried score (OR 4·33 [95%CI: 2·03-9·24] or the Clinical Frailty Score≥5 (OR 3·79 [95%CI: 1·76-8·15), six months fall history (OR 3·46 [95%CI: 1·58-7·63]). The final multivariate model included age>75 (OR 4·64 [95%CI: 2·36-9·39], p<0.001) and impaired IADL8 (OR 5·69 [95%CI: 2·90-11·47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85].

Interpretation: Age and IADL8 provide independent prognostic factors for day-30 mortality in patients over 60 admitted in ICU for severe COVID-19 infection. Our triage model proposes 3 classes of day-30 mortality risks: 8-14% for patients younger than 80 with no impairment in IADL, 30-40% for patients either younger than 70 with at least one impairment in IADL8 or older than 80 with no impairment in IADL and 67-88% for patients over 80 with at least one impairment in IADL.

Trial Registration: ClinicalTrials platform on June 9, 2020 (NCT04422340).

Funding Statement: Hospices Civils de Lyon

Declaration of Interests: All the authors declare grants from Hospices Civils de Lyon, during the conduct of the study, no other competing interests with the considered topic. CF reports outside of the present work consulting/advisory roles for GSK, Leo Pharma, Pfizer, MSD Oncology, Teva, AstraZeneca, Baxter, Eisai, Janssen, and Novartis; research funding from Chugai Pharma, Pfizer, Pierre Fabre, and Astellas Pharma; and travel/accommodation/expenses from Janssen Oncology, Pierre Fabre, and Leo Pharma.

Ethics Approval Statement: The study protocol (V1.0 of April 7, 2020) was approved by a COVID-19-dedicated Ethics Committee of the Hospices Civils de Lyon on May 12, 2020.

Suggested Citation

Falandry, Claire and Bitker, Laurent and Abraham, Paul and Subtil, Fabien and Collange, Vincent and Balança, Baptiste and Haïne, Max and Guichon, Céline and Leroy, Christophe and Simon, Marie and Malapert, Amélie and Roche, Mélanie and Pialat, Jean-Baptiste and Jallades, Laurent and Lepape, Alain and Friggeri, Arnaud and Thiolliere, Fabrice and Group, Senior-COVID-Rea Study, Senior-COVID-Rea Multicentre Observational Cohort Study: Development of a Geriatric Prediction Model of Day 30 Mortality in Patients Over 60 in ICU. Available at SSRN: https://ssrn.com/abstract=3742290 or http://dx.doi.org/10.2139/ssrn.3742290

Claire Falandry (Contact Author)

Centre Hospitalier Universitaire Lyon Sud ( email )

Pierre Bénite
France

Laurent Bitker

Independent ( email )

Paul Abraham

Independent

Fabien Subtil

Independent ( email )

Vincent Collange

Independent ( email )

Baptiste Balança

Independent ( email )

Max Haïne

Independent ( email )

Céline Guichon

Independent ( email )

Christophe Leroy

Independent

Marie Simon

Independent ( email )

Amélie Malapert

Independent ( email )

Mélanie Roche

Independent ( email )

Jean-Baptiste Pialat

Independent ( email )

Laurent Jallades

Independent ( email )

Alain Lepape

Independent ( email )

Arnaud Friggeri

Independent ( email )

Fabrice Thiolliere

Independent ( email )

No contact information is available for Senior-COVID-Rea Study Group

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