Abstract: (2022) 22:1000 Baldia et al. BMC Geriatrics https://doi.org/10.1186/s12877-022-03709-w Open Access RESEARCH The association of prior paracetamol intake with outcome of very old intensive care patients with COVID‑19: results from an international prospective multicentre trial Philipp Heinrich Baldia1, Bernhard Wernly2, Hans Flaatten3, Jesper Fjølner4, Antonio Artigas5, Bernardo Bollen Pinto6, Joerg C. Schefold7, Malte Kelm1, Michael Beil8, Raphael Romano Bruno1, Stephan Binnebößel1, Georg Wolff1, Ralf Erkens1, Sviri Sigal8, Peter Vernon van Heerden8, Wojciech Szczeklik9, Muhammed Elhadi10, Michael Joannidis11, Sandra Oeyen12, Brian Marsh13, Finn H. Andersen14, Rui Moreno15, Susannah Leaver16, Dylan W. De Lange17, Bertrand Guidet18, Christian Jung1* and COVIP study group Abstract Background: In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. Methods: This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. Results: 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2–5 versus IQR 2–4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. *Correspondence: christian.jung@med.uni-duesseldorf.de 1 Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany Full list of author information is available at the end of the article © The Author(s) 2022. 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..