• Bernhard Wernly, Richard Rezar, Hans Flaatten, Michael Beil, Jesper Fjølner, Raphael R Bruno, Antonio Artigas, Bernardo B Pinto, Joerg C Schefold, Malte Kelm, Sviri Sigal, van HeerdenPeter VPVDepartment of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Georg Wolff, Brian Marsh, Finn H Andersen, Rui Moreno, Susannah Leaver, Sarah Wernly, Ariane Boumendil, Dylan W De Lange, Bertrand Guidet, Christian Jung, and COVIP study group.
• Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.
• J. Intern. Med. 2022 Sep 1; 292 (3): 438-449.

BackgroundPrevious studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.ObjectivesThe 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.MethodsA 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.ResultsThe 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).ConclusionThis 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.© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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