Variations in end‐of‐life care practices in older critically ill patients with COVID‐19 in Europe Academic Article uri icon

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  • Background

    Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.


    The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic.


    A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome.


    The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78).


    This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.


  • Wernly, Bernhard
  • Rezar, Richard
  • Flaatten, Hans
  • Beil, Michael
  • Fjølner, Jesper
  • Bruno, Raphael R
  • Artigas, Antonio
  • Pinto, Bernardo B
  • Schefold, Joerg C
  • Kelm, Malte
  • Sigal, Sviri
  • van Heerden, Peter V
  • Szczeklik, Wojciech
  • Elhadi, Muhammed
  • Joannidis, Michael
  • Oeyen, Sandra
  • Wolff, Georg
  • Marsh, Brian
  • Andersen, Finn H
  • Moreno, Rui
  • Leaver, Susannah
  • Wernly, Sarah
  • Boumendil, Ariane
  • De Lange, Dylan W
  • Guidet, Bertrand
  • Jung, Christian

publication date

  • September 2022