Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Abstract

Background Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. Methods This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). Results Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79). Conclusions Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

Clinical Characteristics and Predictors of Complications and Mortality in Hospitalized Octogenarian Patients with COVID-19: An Ambispective Study

“…as the most common symptoms in cohorts of elderly Spanish patients hospitalized for COVID-19. [23][24][25] Consistent with the ndings of other studies, the elderly individuals in our cohort predominantly presented elevated in ammatory markers, such as ferritin and CRP, and frequent elevation of D-dimer and LDH. 23,24 This laboratory pro le did not differ across the various epidemic waves.…”

“…Other cohort studies assessing hospitalized elderly patients have reported acute kidney injury, which is likely related to tubular injury caused by local and systemic in ammation and immune systems, aggravated by hemodynamic instability. 23,24,30 Moreover, underlying chronic kidney disease is frequent among octogenarians, further contributing to an increased risk of developing acute kidney injury during hospitalization.…”

Rivaroxaban for Prevention of Thrombotic Events, Hospitalization, and Death in Outpatients With COVID-19: A Randomized Clinical Trial

“…In a study of 243 outpatients with COVID-19, sulodexide, an oral mixture of glycosaminoglycans (low-molecular-weight heparin and dermatan sulfate), decreased the need for hospitalization. 23 Although thromboinflammation was suggested as a final common pathway for clinical deterioration early in the pandemic, 24 , 25 subsequent data support non–thrombosis-based cardiovascular diseases 26 , 27 such as heart failure and sepsis as greater contributors to morbidity and mortality. 4 , 28 A reduction in thrombosis, clinical deterioration, and death in patients with COVID-19 has also been explained by more widespread implementation of corticosteroids, monoclonal antibodies, and antiviral agents, as well as nearly 70% of the population being fully vaccinated.…”

Comparison of clinical characteristics, hospital treatment and outcomes in all four waves of Covid-19 patients at RTEH Muzaffargarh, Pakistan

“…Ramos-Rincon JM et al 17 studied older population in Spain. The study included 4545 cases during the first wave, and 1408 cases in the successive waves.…”