The COVID19 disease in Very Elderly Intensive care Patients (COVIP) study


Background

The COVID-19 pandemic is threatening numerous countries worldwide. Preliminary reports of critically ill COVID-19 patients in Wuhan (China) and Italy have reported a high risk of death in patients with multimorbidity. Also, very old patients with SARS-CoV-2 infections suffered from high mortality rates (1). It is, however, unclear if age alone is an independent risk factor, or if co-morbiditites and frailty trigger the adverse outcome. During the pandemic, treating and triaging elderly COVID-19 may challenge our health care systems.

In non-COVID-19 elderly patients admitted to the ICU, our European research group (2) found that the co-factors are more important than chronological age itself (3, 4).

In patients with COVID-19, pretreatment with angiotensin-blockers and ACE-inhibitors (5) and nonsteroidal anti-inflammatory drugs such as ibuprofen (6) were suggested to be associated with adverse outcome. Furthermore, some groups have reported a higher death rate in patients with concomitant cardiovascular disease (7) and diabetes (8).

This international, multicenter study group (VIP-network) will conduct a prospective, observational study to examine the relationship between age, co-morbidities, pretreatment frailty and outcomes in a group of elderly patients receiving critical care for COVID-19.

The results will be essential to understand which factors can predict mortality in elderly COVID-19 patients to help to detect these patients early. Furthermore, this study will also be a knowledge base necessary to guide triage decisions in the future. With this pandemic likely to continue for 18 months, it is paramount to identify independent risk factors early to facilitate both risk stratification and substantiate necessary triage decisions. The pandemic begins in many countries worldwide now, and a decisive action of the research community is needed.

The study is endorsed by The European Intensive Care Society (ESICM), can be followed on ResearchGate and is registered on ClinicalTrials.gov (NCT04321265).


Documents

Case record form: Download

Protocol: Download


Country coordinators and steering group


Christian JungPrinciple Investigator of the COVIP study and German coordinatorDusseldorf, Germanychristian . jung @ med . uni-duesseldorf . de
Jesper FjølnerCo-Principle investigator in the COVIP study, Danish coordinator, datamanagerAarhus, Denmarkjespfjoe @ rm . dk
Hans FlaattenPrincipal Investigator of the VIP study group, Past chair HSRO section,Bergen, Norwayhans . flaatten @ uib . no
Antonio ArtigasSpanish coordinatorBarcelona, Spainaartigas @ tauli . cat
Bernardo Bollen PintoSwiss coordinatorGeneva, Switzerlandbernardo . bollenpinto @ hcuge . ch
Bertrand GuidetCo-Principal Investigator of the VIP study group and French coordinatorParis, Francebertrand . guidet @ aphp . fr
Brian MarshIrish coordinatorDublin, Irelandbmarsh @ mater . ie
David AstapenkoCzech Republic coordinatorHradec Kralove, Czech Republicastapenko . d @ seznam . cz
Dylan deLangeThe Netherlands coordinator and Chair of ESICM HSRO sectionUtrecht, The Netherlandsd . w . delange @ umcutrecht . nl
Finn AndersenNorwegian coordinatorÅlesund, Norwayfinn . h . andersen @ helse-mr . no
Michael JoannidisAustrian coordinatorInnsbruck, Austriamichael . joannidis @ i-med . ac . at
Muhammed ElhadiLybian coordinatorTripoli, Libyamuhammed . elhadi . uot @ gmail . com
Rokas SerpytisLithuanian coordinatorVilnius, Lithuaniarserpytis @ gmail . com
Rui MorenoPortuguese coordinatorLisboa, Portugalr . moreno @ mail . telepac . pt
Sigal SviriIsraeli coordinatorJerusalem, Israelsigal . sviri @ gmail . com
Sandra OeyenBelgium coordinatorGhent, Belgiumsandra . oeyen @ ugent . be
Sten WaltherSwedish coordinatorLinkoping, Swedensten . walther @ telia . com
Susannah LeaverUnited Kingdom coodinatorLondon, Englandsusannahleaver @ nhs . net
Tilemachos ZafeiridisGreek coordinatorLarissa, Greecetilemachos @ hotmail . com
Wojciech SzczeklikPolish coordinatorKrakow, Polandwszczeklik @ gmail . com
Yuriy NalapkoUkranian coordinatorLugansk, Ukrainenalapko @ ukr . net
Ariane BoumendilStatisticianParis, Franceariane . boumendil @ gmail . com
Bernhard WernlyCo-Investigator and scientific supportSalzburg, Austriabernhard @ wernly . net
Raphael R. BrunoCo-Investigator and scientific supportDüsseldorf, Germanyraphael . bruno @ med . uni-duesseldorf . de

Scales/scores utilized

Clinical Frailty Scale

The Clinical Frailty Scale (CFS) is a simple point scale with short descriptions and visualizations of levels of frailty. †The CSF is composed of nine classes from very fit to terminally ill. The English version is used for this study.

KATZ ADL


References

  1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.
  2. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319-28.
  3. Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820-8.
  4. Guidet B, de Lange DW, Boumendil A, Leaver S, Watson X, Boulanger C, et al. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study. Intensive Care Med. 2020;46(1):57-69.
  5. [Available from: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang.
  6. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020;368:m1086.
  7. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020.
  8. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020.