Predictors of COVID‑19‑associated mortality among hospitalized elderly patients with dementia

Abstract

The mortality of elderly patients with dementia hospitalized with coronavirus disease 2019 (COVID-19)-associated pneumonia is high. The mortality rate of these patients continues to be high following their discharge. However, data on the outcomes of these patients in all phases of the pandemic are limited. The aim of the present study was to examine the clinical characteristics and the in-hospital and 90-day mortality rates of elderly patients with dementia hospitalized due to COVID-19-associated pneumonia during all phases of the pandemic. During the time period between February 15, 2021 to July 15, 2022, 105 elderly patients (≥65 years old) with dementia of various etiologies were hospitalized due to COVID-19-associated pneumonia. The patient characteristics and in-hospital outcomes within 90 days of admission were recorded. The mean age of the patients was 84.03±7.61 years and 60 (57.1%) patients were females. A total of 52 (49.5%) patients were hospitalized during the omicron variant period, 27 (25.7%) were fully vaccinated (three doses) and 38 (36.2%) patients succumbed during their hospitalization. In total, 52 (49.5%) patients succumbed within the first 90 days of admission. According to the univariate regression analysis, the omicron variant [hazard ratio (HR), 2.126; 95% confidence interval (CI), 1.073-4.213; P=0.031] and the absence of full vaccination (HR, 6.231; 95% CI, 1.500-25.87; P=0.012) were associated with a higher in-hospital mortality. In the multivariate regression analysis, only the absence of complete vaccination was an independent predictor of mortality (HR, 5.182; 95% CI, 1.205-22.28; P=0.027). According to the univariate regression analysis, age (HR, 1.045; 95% CI, 1.006-1.085; P=0.023) and the lack of complete vaccination (HR, 3.254; 95% CI,; P=0.012) were associated with 90-day mortality; in addition, by multivariate regression analysis, age (HR, 1.047; 95% CI, 1.007-1.048; P=0.021) and the absence of full vaccination (HR, 3.286; 95% CI, 1.307-8.265; P=0.011) exhibited an independent association with the 90-day mortality rate. Based on the findings presented herein, the in-hospital and 90-day mortality rates of elderly patients with dementia and COVID-19-associated pneumonia is high. An older age and the lack of complete vaccination are independently associated with poor outcomes.

Risk factors for the in‑hospital and 1‑year mortality of elderly patients hospitalized due to COVID‑19‑related pneumonia

“…Dementia is also a well-established risk factor for the poor outcomes of elderly patients hospitalized due to COVID-19 ( 43 , 44 ) and according to the present study, it was an independent risk factor for 1-year mortality.…”

A mid‑pandemic night's dream: Melatonin, from harbinger of anti‑inflammation to mitochondrial savior in acute and long COVID‑19 (Review)

“…This wide distribution likely explains the multisystem involvement of the infection, while also enhancing the magnitude of the illness in patients afflicted by SARS-CoV-2 ( 49 ). Interstitial pneumonia, the most prevalent lung involvement in patients with COVID-19, if left untreated, may lead to a hypoxic status, resulting in acute respiratory distress syndrome and/or systemic inflammatory response syndrome and fatal multiorgan failure ( 3 , 6 , 13 , 15 , 37 , 108 , 112 , 113 ). These sepsis-related consequences occur from a pathophysiological perspective, have the same underlying backgrounds, ignited by the cytokine storm and hyperinflammatory statuses with significant oxidative damage caused by the reaction of the host to SARS-CoV-2 ( 49 , 114 ).…”

“…It is possible that the widespread extrapulmonary damage observed in patients with COVID-19 may be attributed to the presence of ACE2 receptors on cells other than those that lining the respiratory alveoli ( 113 ). Other organ involvement results in symptoms that are particular to the organ; for example, gastrointestinal involvement may cause symptoms such as nausea, vomiting, diarrhea and abdominal pain ( 113 ). Hepatic damage, as evidenced by increased levels of circulating liver enzymes, is also prevalent ( 3 ).…”

The parallel lives of pandemics: COVID‑19 and obesity

“…Although at first glance these pandemics appear to be distinct, further investigations reveal that they have some striking parallels. Both COVID-19 and obesity are influenced by the same pre-existing health conditions and risk factors, such as an advanced age, a deteriorated socio-economic status and co-existing health conditions (2,(11)(12)(13)(14)(15). Comorbidities, such as type 2 diabetes mellitus and cardiovascular disorders, as well as cancer, are typically the result of obesity, which contribute to unfavorable COVID-19 outcomes (2,(16)(17)(18)(19)(20).…”