The COVID19 disease in Very Elderly Intensive care Patients (COVIP) study
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.
Country coordinators and steering group
|Christian Jung||Principle Investigator of the COVIP study and German coordinator||Dusseldorf, Germany||christian . jung @ med . uni-duesseldorf . de|
|Jesper Fjølner||Co-Principle investigator in the COVIP study, Danish coordinator, datamanager||Aarhus, Denmark||jespfjoe @ rm . dk|
|Hans Flaatten||Principal Investigator of the VIP study group, Past chair HSRO section,||Bergen, Norway||hans . flaatten @ uib . no|
|Antonio Artigas||Spanish coordinator||Barcelona, Spain||aartigas @ tauli . cat|
|Bernardo Bollen Pinto||Swiss coordinator||Geneva, Switzerland||bernardo . bollenpinto @ hcuge . ch|
|Bertrand Guidet||Co-Principal Investigator of the VIP study group and French coordinator||Paris, France||bertrand . guidet @ aphp . fr|
|Brian Marsh||Irish coordinator||Dublin, Ireland||bmarsh @ mater . ie|
|David Astapenko||Czech Republic coordinator||Hradec Kralove, Czech Republic||astapenko . d @ seznam . cz|
|Dylan deLange||The Netherlands coordinator and Chair of ESICM HSRO section||Utrecht, The Netherlands||d . w . delange @ umcutrecht . nl|
|Finn Andersen||Norwegian coordinator||Ålesund, Norway||finn . h . andersen @ helse-mr . no|
|Michael Joannidis||Austrian coordinator||Innsbruck, Austria||michael . joannidis @ i-med . ac . at|
|Muhammed Elhadi||Lybian coordinator||Tripoli, Libya||muhammed . elhadi . uot @ gmail . com|
|Rokas Serpytis||Lithuanian coordinator||Vilnius, Lithuania||rserpytis @ gmail . com|
|Rui Moreno||Portuguese coordinator||Lisboa, Portugal||r . moreno @ mail . telepac . pt|
|Sigal Sviri||Israeli coordinator||Jerusalem, Israel||sigal . sviri @ gmail . com|
|Sandra Oeyen||Belgium coordinator||Ghent, Belgium||sandra . oeyen @ ugent . be|
|Sten Walther||Swedish coordinator||Linkoping, Sweden||sten . walther @ telia . com|
|Susannah Leaver||United Kingdom coodinator||London, England||susannahleaver @ nhs . net|
|Tilemachos Zafeiridis||Greek coordinator||Larissa, Greece||tilemachos @ hotmail . com|
|Wojciech Szczeklik||Polish coordinator||Krakow, Poland||wszczeklik @ gmail . com|
|Yuriy Nalapko||Ukranian coordinator||Lugansk, Ukraine||nalapko @ ukr . net|
|Ariane Boumendil||Statistician||Paris, France||ariane . boumendil @ gmail . com|
|Bernhard Wernly||Co-Investigator and scientific support||Salzburg, Austria||bernhard @ wernly . net|
|Raphael R. Bruno||Co-Investigator and scientific support||Düsseldorf, Germany||raphael . bruno @ med . uni-duesseldorf . de|
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.
- 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.
- 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.
- 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.
- 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.
- [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.
- Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020;368:m1086.
- 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.
- 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.