Outcome of patients >75 with COVID-19 severe acute respiratory insufficiency (SARI)

Both the preliminary reports of critically ill COVID-19 patients in Wuhan (China) and Italy reported a high risk of dying in patients with multimorbidity. Also, very old patients with SARS-CoV-2 infections suffered from high mortality rates. It is, however, unclear if age alone is an independent risk factor, or if co-morbid conditions and frailty trigger the adverse outcome. In non-COVID-19 elderly patients admitted to the ICU, our European research group found that the co-factors are more important than chronological age itself. In patients with COVID-19, pretreatment with AT-2 blockers and ACE-inhibitors, but also nonsteroidal anti-inflammatory drugs such as ibuprofen were suggested to be associated with adverse outcome. Furthermore, some groups reported a higher death rate in patients with concomitant cardiovascular disease and diabetes. This international multicenter study group, therefore, proposes to study the relationship between age, co-morbidities, pretreatment, frailty, and outcomes prospectively in a group of elderly patients receiving critical care for COVID-19. The results of this investigation will be essential to understand which factors can predict mortality in elderly COVID-19 patients to help to detect these patients early. Furthermore, the proposed 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 all European countries now, and decisive action of the research community is needed.

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