Absence of negativization of nasal swab test and frailty as risk factors for mortality in elderly COVID-19 patients admitted in long-term care facilities

Pagliuca, Raffaele; Cupido, Maria Grazia; Mantovani, Giacomo; Bugada, Maura; Matteucci, Giulia; Caffarelli, Arturo; Bellotti, Federico; Cocchieri, Raffaella; Dentale, Antonio; Lozzi, Federica; Malagoli, Piergiorgio; Morabito, Pasquale; Serra, Gianluca; Andreati, Candida

doi:10.1007/s41999-022-00657-x

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…As much as 50% of frail patients that had positive identification of the virus died before 28 days, while 25-35% of those that had COVID-19 diagnosis but not positive identification of the virus died in the same period. In Italy, frailty was associated with increasing COVID-19 mortality in long-term care [26] and in hospital admittance [27]. Paradoxically, a systematic review [28] did not show a relation between COVID-19 mortality at the hospital and frailty, because non frail patients were prioritized to receive invasive mechanical ventilation that resulted in much worse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

Cano‐Escalera

Graña

Irazusta

et al. 2023

JCM

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Background: Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. Materials: Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. Methods: Kaplan–Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0–05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. Results: Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29–0.66)), age (1.05 (1.01–1.09)), weight (0.98 (0.96–1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41–0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33–0.74)), SPPB sit and stand (0.62 (0.45–0.85)), heart failure (0.67 (0.46–0.98)), use of antiplatelets (1.80 (1.19–2.71)), and quetiapine (0.31 (0.12–0.81)). Specific high-risk factors in the pre-frail cohort are Barthel’s score (120 (7.7–1700)), Pfeiffer test (8.4; (2.3–31)), Mini Nutritional Assessment (MNA) (1200 (18–88,000)), constipation (0.025 (0.0027–0.24)), falls (18,000 (150–2,200,000)), deep venous thrombosis (8400 (19–3,700,000)), cerebrovascular disease (0.01 (0.00064–0.16)), diabetes (360 (3.4–39,000)), thyroid disease (0.00099 (0.000012–0.085)), and the use of PPIs (0.062 (0.0072–0.54)), Zolpidem (0.000014 (0.0000000021–0.092)), antidiabetics (0.00015 (0.00000042–0.051)), diuretics (0.0003 (0.000004–0.022)), and opiates (0.000069 (0.00000035–0.013)). Conclusions: Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.

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Section: Introductionmentioning

confidence: 99%

Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

Cano‐Escalera

Graña

Irazusta

et al. 2023

JCM

View full text Add to dashboard Cite

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Predictors of prolonged hospitalization of COVID-19 patients

et al. 2023

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Long COVID-19 Syndrome and Frailty: Cause or Consequence or Both?

Marks

2023

JARH

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Background Many older adults remain vulnerable to COVID-19 infections. They are also often at risk for frailty and poor health outcomes. Aim This exploratory review examines the correlates of long COVID and frailty and their association insofar as the older adult’s wellbeing may be jeopardized. Methods and procedures Articles that emerged between January 1 2022 and 2023 in major electronic data bases that addressed the current topic of interest were sought using the key words: Long COVID and Frailty. Those deemed relevant were duly downloaded, analyzed and summarized in narrative form. Results A high proportion of older adults can be expected to remain vulnerable to COVID-19 long term impacts, plus new variants of infection, along with frailty as both an outcome and mediator. Many too are at risk for persistent long COVID-19 complications and a low life quality if more concerted preventive and rehabilitation efforts to avert frailty early on are not forthcoming in a timely manner. Conclusion Prompt and continuing frailty assessments of older adults at risk for COVID-19 or recovering from this disease, especially those with long COVID manifestations who are frail or may become frail are strongly indicated.

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Absence of negativization of nasal swab test and frailty as risk factors for mortality in elderly COVID-19 patients admitted in long-term care facilities

Cited by 4 publications

References 34 publications

Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

Predictors of prolonged hospitalization of COVID-19 patients

Long COVID-19 Syndrome and Frailty: Cause or Consequence or Both?

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