Skip to main content

The impact of frailty on survival in elderly intensive care patients with COVID‑19: do not dismiss intensive care unit overcrowding

To the Editor:

Recently in the Journal, Jung et al. [1] reported that frailty, age and comorbidities provide relevant prognostic information among elderly COVID-19 patients admitted to intensive care unit (ICU). While we fully agree with the authors claiming that the decision-making process relies on multi-components, COVID-19 pandemic, per se, implies cautions for the results interpretation. Firstly, the unprecedented influx of patients into hospitals and ICUs faced the physicians to a supplemental issue, the mismatch between means and resources [2, 3]. That was a crux in some low-income and middle-income countries (LMICs), at the origin of difficult daily triage decisions against the backdrop of severe shortages of basic equipment and consumables [4]. Secondly, the wide disparity for the reasons and the use of end-of-life care decisions due to cultural considerations could have induced a bias in this multicenter study from 28 countries. Thirdly, it would have been more representative to include in the analysis all frail patients: those younger than 70 years old, and those not admitted in ICU whatever the underlying reason [3, 5]. Last but not least, the relative weight of frailty, age and comorbidities covariates on outcome would be helpful to physicians in the day-by-day decision-making process, but the question is if one factor should be more important to consider than the others? Nevertheless, beyond all these limitations, we fully agree with Jung et al. that frailty assessment is one of the utmost important elements to take into account among COVID-19 patients, especially in elderlies [1].

Availability of data and materials

Not applicable.

References

  1. 1.

    Jung C, Flaatten H, Fjølner J, et al. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study. Crit Care. 2020;25(1):149.

    Article  Google Scholar 

  2. 2.

    Azoulay E, Beloucif S, Guidet B, Pateron D, Vivien B, Le Dorze M. Admission decisions to intensive care units in the context of the major COVID-19 outbreak: local guidance from the COVID-19 Paris-region area. Crit Care. 2020;24(1):293.

    Article  Google Scholar 

  3. 3.

    Tyrrell CSB, Mytton OT, Gentry SV, Thomas-Meyer M, Allen JLY, et al. Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review. Thorax. 2021;76(3):302–12.

    Article  Google Scholar 

  4. 4.

    Mehta S, Machado F, Kwizera A, Papazian L, Moss M, Azoulay É, Herridge M. COVID-19: a heavy toll on health-care workers. Lancet Respir Med. 2021;9(3):226–8.

    CAS  Article  Google Scholar 

  5. 5.

    Maltese G, Corsonello A, Di Rosa M, Soraci L, Vitale C, Corica F, Lattanzio F. Frailty and COVID-19: a systematic scoping review. J Clin Med. 2020;9(7):66.

    Article  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Affiliations

Authors

Contributions

RJ and BV wrote and revised the manuscript. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Benoît Vivien.

Ethics declarations

Ethical approval and consent to participate

Not applicable.

Consent for publication

RJ and BV consent for publication.

Competing interests

RJ and BV have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jouffroy, R., Vivien, B. The impact of frailty on survival in elderly intensive care patients with COVID‑19: do not dismiss intensive care unit overcrowding. Crit Care 25, 225 (2021). https://doi.org/10.1186/s13054-021-03653-y

Download citation