Clinical effectiveness of intensive care unit admission in older adults with COVID-19 during the first pandemic wave in Spain

Abstract

Objective: To evaluate the impact of ICU admission on mortality and complications of older patients with COVID-19 hospitalized during the first COVID-19 wave in our setting. Methods :An observational, multicenter, and ambispective study of COVID-19 patients aged > 70 years who were hospitalized during the first wave of the pandemic in the southern metropolitan area of Barcelona, Spain. The primary outcome of the study was the in-hospital mortality rate of patients admitted to the ICU compared with their appropriately matched controls who received care in hospital wards. The secondary outcome was the in-hospital rate of complications in ICU-admitted patients versus their matched controls. Results: The mortality rate was 76.6% in ICU-admitted patients and 64.9% among their matched controls, whereas the corresponding rates of complications were 73.5% and 32.4%, respectively. ICU admission shows a statistically significant impact on mortality (OR [95% CI] 2.50 [1.06–6.05]; p = 0.041). Additionally, complications were four times more likely in patients who were admitted to ICUs than in those admitted to general wards (OR [95% CI] 4.03 [1.64–9.91]; p = 0.0024). Conclusions: ICU admission was not associated with improved survival in patients older than 70 years during the first COVID-19 wave. Further research is needed to confirm these findings and to assess the adequacy of ICU admission criteria for elderly patients.