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Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study
Aline Mendes1, Christine Serratrice2, François R Herrmann1
1Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
Insights
Male sex, crackles, increased oxygen needs, and poorer functional status predict COVID-19 mortality in older patients. These factors, not age alone, are key for prognosis assessment.
Area of Science:
- Gerontology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 poses a significant threat to older adults, with high in-hospital mortality rates.
- Predicting mortality in elderly patients with COVID-19 is crucial for resource allocation and treatment strategies.
Purpose of the Study:
- To identify predictors of in-hospital mortality in patients aged 65 and older diagnosed with COVID-19.
- To establish key clinical parameters for assessing prognosis in elderly COVID-19 patients.
Main Methods:
- Retrospective cohort study analyzing electronic medical records of 235 Caucasian patients aged 65+ hospitalized for COVID-19.
- Logistic regression and Cox proportional hazard models were employed to identify mortality predictors.
- Data included demographics, clinical history, comorbidities, vital signs, laboratory results, and imaging.
Main Results:
- In-hospital mortality was 32% (76/235 patients).
- Nonsurvivors exhibited shorter time from symptoms to hospitalization, higher prevalence of heart failure, peripheral artery disease, crackles, increased respiratory rate, oxygen support needs, elevated C-reactive protein, and bilateral infiltrates.
- Multivariable Cox model identified male sex, increased fraction of inspired oxygen, and crackles as independent predictors of mortality, while better functional status was protective.
Conclusions:
- Male sex, presence of crackles, higher oxygen requirements, and poorer functional status are significant independent predictors of mortality in older COVID-19 patients.
- Routine clinical parameters, rather than solely age, should guide prognostic evaluation in this demographic.
- These findings aid in risk stratification and clinical decision-making for elderly COVID-19 patients.
Objective:
To determine predictors of in-hospital mortality related to COVID-19 in older patients.
Design:
Retrospective cohort study.
Setting And Participants:
Patients aged 65 years and older hospitalized for a diagnosis of COVID-19.
Methods:
Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results.
Results:
Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001).
Conclusions And Implications:
In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.
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