End‐of‐life decision‐making in critically ill old patients with and without coronavirus disease 2019

Abstract

AbstractBackgroundThere are few studies on the differences in end‐of‐life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID‐19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life‐sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID‐19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit.MethodsThis observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non‐invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals.ResultsThere were 394 patients included in this study, 131 in the non‐COVID‐19 group and 263 in the COVID‐19 group. For the non‐COVID‐19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life‐sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03–1.19) p = .009 and 1.06 (1.03–1.10) p < .001, respectively. For the COVID‐19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life‐sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life‐sustaining treatments, with an odds ratio of 1.26 (1.07–1.49), p = .006.ConclusionDecisions to withdraw or withhold life‐sustaining treatments were based on other variables for the critically ill COVID‐19 cohort compared to those for the critically ill non‐COVID‐19 cohort. Further studies are warranted to forge a common path for ethical end‐of‐life decision‐making in critically ill patients.