Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain

Abstract

Background Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1–May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. Results 2,772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index <60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n:1,301) and increased with age (80-84 years:41.6%; 85-90 years:47.3%; 90-94 years:52.7%; ≥95 years:54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: SatO2 <90%; temperature ≥37.8ºC; qSOFA score ≥2; and unilateral-bilateral infiltrates on chest X-rays. Some analytical findings were independent risk factors for death, including eGFR <45 ml/min/1.73m 2; lactate dehydrogenase ≥500 U/L; CRP ≥80 mg/L; neutrophils ≥7.5x10 3/μL; lymphocytes <0.8x10 3/μL; and monocytes <0.5 x 10 3/μL. Conclusions This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor pre-admission functional status—not comorbidities—are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.

Covid-19 in the Oldest-old Population (80 and Older): Clinical Presentation and Prognostic Factors of Severe Disease and Mortality. A Cohort Study.

“…In a younger cohort, Mostaza et al (20), in people older than 75 years, did nd a better prognosis in patients who previously took reninangiotensin-aldosterone system antagonists. Regarding previous chronic diseases, our results are similar to the study by Ramos-Rincon et al (9); however, Covino et al (10) reported severe dementia as an independent risk factor for death, although age, since it was not apparently included in their multivariate analysis, cannot be rule out as a confounding factor.…”

“…The trials by Gutiérrez-Rodríguez et al (11) and Covino et al (10) did not nd that age or sex were predictors of mortality either. However, Ramos-Rincon et al (9) reported age and male sex as predictors of mortality from a multicentre cohort of 2772 very old hospitalized patients so we cannot rule out a lack of statistical power of our sample in these results.…”

“…Serum sodium was a predictor of mortality in our sample. Of the aforementioned studies, Gutiérrez-Rodríguez et al (11) did not nd a signi cant association in their bivariate analysis, and Ramos-Rincon et al (9) and Covino et al (10) did not include this parameter in their reports. Below, we propose a hypothesis for this result.…”

Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain

“…Aging is one of the most signi cant factors associated with a poor prognosis in coronavirus disease-2019 (COVID-19) [1][2][3][4]. In addition, diabetes is a common comorbidity among patients with severe COVID-19 [5,6] and while it does not increase susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it has also been correlated with a more severe course of COVID-19 [7,8].…”

COVID-19: Clinical Presentation and Prognostic Factors of Severe Disease and Mortality in the Oldest-old Population. A Cohort Study.

“…There are few studies speci cally reporting on clinical presentation and prognostic factors in the oldestold population [9][10][11]. The main reported symptoms of clinical presentation have included fever, dyspnoea, cough, and deterioration of functional status; and factors associated with higher mortality included age, male sex, severe functional dependence, cognitive decline, renal function, and in ammatory markers.…”