Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study

Assis, Fábio Cavalcante de; Silva, Michelle Cristina-Oliveira da; Júnior, João Carlos Geber; Roschel, Hamilton; Peçanha, Tiago; Drager, Luciano F.; Santana, Alfredo Nicodemos Cruz

doi:10.6061/clinics/2021/e3369

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…However, few studies have evaluated the role of the Vulnerable Elders Survey (VES-13) in predicting clinical outcomes of hospitalized patients [15,16]. One of the recent studies, based on the small cohort (n=91) suggests that elderly patients (>60 years) classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19-super vulnerability was an independent predictor of death and the need for invasive mechanical ventilation during hospitalizationa final VES-13 score between 8 and 10 was associated with poor outcomes [17]. Our results show a lack of significant differences in the VES-13 between the three C2HEST strata.…”

Section: Discussionmentioning

confidence: 99%

Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

Rola

Doroszko

Trocha

et al. 2022

JCM

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Senility has been identified among the strongest risk predictors for unfavorable COVID-19-outcome. However, even in the elderly population, the clinical course of infection in individual patients remains unpredictable. Hence, there is an urgent need for developing a simple tool predicting adverse COVID-19-outcomes. We assumed that the C2HEST-score could predict unfavorable clinical outcomes in the elderly subjects with COVID-19-subjects. Methods: We retrospectively analyzed 1047 medical records of patients at age > 65 years, hospitalized at the medical university center due to COVID-19. Subsequently, patients were divided into three categories depending on their C2HEST-score result. Results: We noticed significant differences in the in-hospital and 3-month and 6-month mortality-which was the highest in high-risk-C2HEST-stratum reaching 35.7%, 54.4%, and 65.9%, respectively. The medium-risk-stratum mortalities reached 24.1% 43.4%, and 57.6% and for low-risk-stratum 14.4%, 25.8%, and 39.2% respectively. In the C2HEST-score model, a change from the low to the medium category increased the probability of death intensity approximately two-times. Subsequently, transfer from the low-risk to the high-risk-stratum raised all-cause-death-intensity 2.7-times. Analysis of the secondary outcomes revealed that the C2HEST-score has predictive value for acute kidney injury, acute heart failure, and cardiogenic shock. Conclusions: C2HEST-score analysis on admission to the hospital may predict the mortality, acute kidney injury, and acute heart failure in elderly subjects with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

Rola

Doroszko

Trocha

et al. 2022

JCM

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“…The relation between the Charlson index and mortality is of special importance as it is in line with our results on SARC-F and the Rockwood Clinical Frailty Scale, all three being comprehensive tools enquiring into a broad spectrum of factors associated with functionality and disease burden in older patients. Similarly, a study by Assis et al demonstrated a relation between the VES-13 result and adverse outcome after hospitalisation due to COVID-19, and a study by Fujita et al reported the relation between worse admission ADL and greater hospital mortality due to COVID-19 [37,38]. The association between frailty and severe COVID-19 infection was estimated among the UK Biobank participants hospitalized from COVID-19 using two frailty classifications: frailty phenotype and the frailty index.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients – the role of sarcopenia and frailty assessment

et al. 2022

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Background COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures. Methods The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay. Results The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65–89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death. Conclusions In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.

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“…In patients 60 years and older, who were hospitalized with COVID-19 infection, VES-13 was performed to estimate the risks of in-hospital mortality and the need for invasive mechanical ventilation. According to research, patients classified as extremely vulnerable (8-10 points in VES-13 score) were strongly and independently associated with a higher relative risk of those outcomes [13].…”

Section: Introductionmentioning

confidence: 99%

Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults

Kravchenko,

Korycka-Bloch,

Stephenson

et al. 2023

Nutrients

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With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.

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Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study

Cited by 4 publications

References 29 publications

Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients – the role of sarcopenia and frailty assessment

Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults

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