Background The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO 2 /FiO 2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO 2 /FiO 2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p < 0·001). Conclusion Patients over 70 years old represented more than a quarter of the COVID-19 population admitted in the participating ICUs during the first wave. Day-90 mortality was 46%, with dismal outcomes reported for patients older than 80 years or those intubated upon ICU admission. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00861-1.
【저자키워드】 COVID-19, Mortality, acute respiratory distress syndrome, intensive care unit, frailty, intubation, Old patients, 【초록키워드】 intensive care, Prognosis, COVID-19 pandemic, Comorbidity, outcome, hypertension, database, ICU, Cohort, older patient, Health, Critically ill, clinical, management, International, Patient, ICU admission, age, scale, First wave, Admission, Care, Analysis, older patients, Intubated, supplementary material, 95% CI, diabetics, hazard ratio, cardiovascular dysfunction, chronic respiratory disease, Future, resources, Result, reported, evaluated, median, significantly higher, reached, diabete, first symptom, PaO, patients older, with COVID-19, 【제목키워드】 Prognosis, ICU, management, Elderly patient, Critically ill patient, with COVID-19,