Autor: Schefold, Joerg C. - Prolib Integro

Skocz do pozycji: 1.

Tytuł:: Consent is a confounding factor in a prospective observational study of critically ill elderly patients
Autorzy:: Guidet, Bertrand
Szczeklik, Wojciech
Nalapko, Yuriy
Boumendil, Ariane
Moreno, Rui
Schefold, Joerg C.
Walther, Sten
Leaver, Susannah
Marsh, Brian
Elhadi, Muhammed
Fjolner, Jesper
Oeyen, Sandra
Flaatten, Hans
Andersen, Finn
de Lange, Dylan W.
Joannidis, Michael
Jung, Christian
Artigas, Antonio
Opis:: During analysis of a prospective multinational observation study of critically ill patients ≥80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requirement for consent at admission but with deferred consent in survivors. Group B: ICUs where some form of active consent at admission was necessary either from the patient or surrogates. Patients’ characteristics, the severity of disease and outcome variables were compared. Totally 3098 patients were included from 21 countries. The median age was 84 years (IQR 81–87). England was not included because of changing criteria for consent during the study period. Group A (7 countries, 1200 patients), and group B (15 countries, 1898 patients) were comparable with age and gender distribution. Cognition was better preserved prior to admission in group B. Group A suffered from more organ dysfunction at admission compared to group B with Sequential Organ Failure Assessment score median 8 and 6 respectively. ICU survival was lower in group A, 66.2% compared to 78.4% in group B (p<0.001). We hence found profound effects on outcomes according to differences in obtaining consent for this study. It seems that the most severely ill elderly patients were less often recruited to the study in group B. Hence the outcome measured as survival was higher in this group. We therefore conclude that consent likely is an important confounding factor for outcome evaluation in international studies focusing on old patients.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: COVID-19 machine learning model predicts outcomes in older patients from various European countries, between pandemic waves, and in a cohort of Asian, African, and American patients
Autorzy:: Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
De Lange, Dylan W.
Pinto, Bernardo Bollen
Schefold, Joerg C.
Leaver, Susannah
Wolff, Georg
Fjolner, Jesper
Wernly, Bernhard
Flaatten, Hans
Beil, Michael
Osmani, Venet
Sigal, Sviri
Jung, Christian
Artigas, Antonio
Kelm, Malte
Mamandipoor, Behrooz
Opis:: Background: COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical decision making. In this regard, machine learning methods have been shown to enhance prognostication, while improving consistency. However, current machine learning approaches have been limited by lack of generalisation to diverse patient populations, between patients admitted at different waves and small sample sizes. Objectives: We sought to investigate whether machine learning models, derived on routinely collected clinical data, can generalise well i) between European countries, ii) between European patients admitted at different COVID-19 waves, and iii) between geographically diverse patients, namely whether a model derived on the European patient cohort can be used to predict outcomes of patients admitted to Asian, African and American ICUs. Methods: We compare Logistic Regression, Feed Forward Neural Network and XGBoost algorithms to analyse data from 3,933 older patients with a confirmed COVID-19 diagnosis in predicting three outcomes, namely: ICU mortality, 30-day mortality and patients at low risk of deterioration. The patients were admitted to ICUs located in 37 countries, between January 11, 2020, and April 27, 2021. Results: The XGBoost model derived on the European cohort and externally validated in cohorts of Asian, African, and American patients, achieved AUC of 0.89 (95% CI 0.89–0.89) in predicting ICU mortality, AUC of 0.86 (95% CI 0.86–0.86) for 30-day mortality prediction and AUC of 0.86 (95% CI 0.86–0.86) in predicting low-risk patients. Similar AUC performance was achieved also when predicting outcomes between European countries and between pandemic waves, while the models showed high calibration quality. Furthermore, saliency analysis showed that FiO2 values of up to 40% do not appear to increase the predicted risk of ICU and 30-day mortality, while PaO2 values of 75 mmHg or lower are associated with a sharp increase in the predicted risk of ICU and 30-day mortality. Lastly, increase in SOFA scores also increase the predicted risk, but only up to a value of 8. Beyond these scores the predicted risk remains consistently high. Conclusion: The models captured both the dynamic course of the disease as well as similarities and differences between the diverse patient cohorts, enabling prediction of disease severity, identification of low-risk patients and potentially supporting effective planning of essential clinical resources.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients : a multicenter prospective observational cohort study
Autorzy:: Mayerhöfer, Timo
De Lange, Dylan W.
Wernly, Bernhard
Flaatten, Hans
Moreno, Rui
Guidet, Bertrand
Sigal, Sviri
Bruno, Raphael Romano
Artigas, Antonio
Szczeklik, Wojciech
Leaver, Susannah
Fjolner, Jesper
Cecconi, Maurizio
Joannidis, Michael
Pinto, Bernardo Bollen
Schefold, Joerg C.
Beil, Michael
van Heerden, Peter Vernon
Jung, Christian
Klein, Sebastian
Opis:: Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan–Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06–1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis. Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: Reliability of the Clinical Frailty Scale in very elderly ICU patients : a prospective European study
Autorzy:: Nalapko, Yuriy
Moreno, Rui
Oeyen, Sandra
Jung, Christian
Artigas, Antonio
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Elhadi, Muhammed
Watson, Ximena
Walther, Sten
Zafeiridis, Tilemachos
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
De Lange, Dylan W.
Opis:: Purpose: Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods: From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions≥80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital fles. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results: 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n=3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from diferent professions. Conclusions: Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient´s condition prior to ICU admission.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: Noninvasive ventilation in COVID-19 patients aged >= 70 years - a prospective multicentre cohort study
Autorzy:: Moreno, Rui
Wernly, Bernhard
Polok, Kamil
Oeyen, Sandra
Artigas, Antonio
Jung, Christian
Studzińska, Dorota
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Bollen Pinto, Bernardo
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
Beil, Michael
Sviri, Sigal
Fronczek, Jakub
de Lange, Dylan W.
Opis:: Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic
Autorzy:: Moreno, Rui
Wernly, Bernhard
Polok, Kamil
Oeyen, Sandra
Artigas, Antonio
Jung, Christian
Studzińska, Dorota
Pinto, Bernardo Bollen
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Andersen, Finn H.
Joannidis, Michael
Bruno, Raphael Romano
Guidet, Bertrand
Szczeklik, Wojciech
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
Beil, Michael
Sviri, Sigal
Fronczek, Jakub
De Lange, Dylan W.
Opis:: Background Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic. Methods We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2—2018 to 2019) and admitted due to COVID-19 (COVIP—March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days). Results The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80). Conclusion The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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Tytuł:: The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years
Autorzy:: Nalapko, Yuriy
Soliman, Ivo W.
Moreno, Rui
Morandi, Alessandro
Andersen, Finn
Oeyen, Sandra
Jung, Christian
Artigas, Antonio
Leaver, Susannah
Marsh, Brian
Fjolner, Jesper
Joannidis, Michael
Elhadi, Muhammed
Watson, Ximena
Walther, Sten
Haas, Lenneke E.M.
Boulanger, Carole
Guidet, Bertrand
Szczeklik, Wojciech
Boumendil, Ariane
Schefold, Joerg C.
Cecconi, Maurizio
Flaatten, Hans
de Lange, Dylan W.
Opis:: Background: Premorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival. Methods: Prospective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS).Results: Overall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3–6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81–86) than patients dying within the first 6 months (median age 84, IQR 82–87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5–6 versus 6 points, IQR 3–6, p < 0.01). Conclusions: We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making.
Dostawca treści:: Repozytorium Uniwersytetu Jagiellońskiego

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