Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19

Falandry, Claire; Bitker, Laurent; Abraham, Paul A.; Subtil, Fabien; Collange, Vincent; Balança, Baptiste; Guichon, Céline; Leroy, C.; Simon, Marie; Malapert, Amélie; Pialat, Jean‐Baptiste; Jallades, Laurent; Lepape, Alain; Friggeri, Arnaud; Thiollière, Fabrice

doi:10.14336/ad.2021.1004

Cited by 6 publications

(4 citation statements)

References 45 publications

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“…Moreover, CMV positive patients younger than 87 years had a higher risk of in-hospital mortality than those without CMV reactivation. Consistent with other investigations, we also found that CRP, neutrophil count and frailty status were significantly associated with in-hospital death [33][34][35], whereas in patients older than 87 years, who were more susceptible to mortality from SARS-CoV-2 infection with respect to the younger group (45% vs. 17%), CMV DNAemia was not associated with death. In accordance with previous evidence, in the oldest group the main factors related to in-hospital mortality were age and an increased neutrophil count [34][35][36].…”

Section: Discussionsupporting

confidence: 91%

“…Consistent with other investigations, we also found that CRP, neutrophil count and frailty status were significantly associated with in-hospital death [33][34][35], whereas in patients older than 87 years, who were more susceptible to mortality from SARS-CoV-2 infection with respect to the younger group (45% vs. 17%), CMV DNAemia was not associated with death. In accordance with previous evidence, in the oldest group the main factors related to in-hospital mortality were age and an increased neutrophil count [34][35][36]. The lack of association between CMV reactivation and in-hospital mortality in the oldest patients could seem unexpected, because of evidence from longitudinal studies, where nonagenarians show CMV T-cell changes (oligoclonal, memory T cells, a reduction in the naïve T cells), in turn associated with frailty and increased mortality [14,37].…”

Section: Discussionsupporting

confidence: 91%

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Effect of Cytomegalovirus Reactivation on Inflammatory Status and Mortality of Older COVID-19 Patients

Giacconi

Cardelli

Piacenza

et al. 2023

IJMS

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Herpesviridae reactivation such as cytomegalovirus (CMV) has been described in severe COVID-19 (COronaVIrusDisease-2019). This study aimed to understand if CMV reactivation in older COVID-19 patients is associated with increased inflammation and in-hospital mortality. In an observational single-center cohort study, 156 geriatric COVID-19 patients were screened for CMV reactivation by RT-PCR. Participants underwent a comprehensive clinical investigation that included medical history, functional evaluation, laboratory tests and cytokine assays (TNF-α, IFN-α, IL-6, IL-10) at hospital admission. In 19 (12.2%) of 156 COVID-19 patients, CMV reactivation was detected. Multivariate Cox regression models showed that in-hospital mortality significantly increased among CMV positive patients younger than 87 years (HR: 9.94, 95% CI: 1.66–59.50). Other factors associated with in-hospital mortality were C-reactive protein (HR: 1.17, 95% CI: 1.05–1.30), neutrophil count (HR: 1.20, 95% CI: 1.01–1.42) and clinical frailty scale (HR:1.54, 95% CI: 1.04–2.28). In patients older than 87 years, neutrophil count (HR: 1.13, 95% CI: 1.05–1.21) and age (HR: 1.15, 95% CI: 1.01–1.31) were independently associated with in-hospital mortality. CMV reactivation was also correlated with increased IFN-α and TNF-α serum levels, but not with IL-6 and IL-10 serum changes. In conclusion, CMV reactivation was an independent risk factor for in-hospital mortality in COVID-19 patients younger than 87 years old, but not in nonagenarians.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Effect of Cytomegalovirus Reactivation on Inflammatory Status and Mortality of Older COVID-19 Patients

Giacconi

Cardelli

Piacenza

et al. 2023

IJMS

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“…The Instrumental Activities of Daily Living Scale 8 and biomarkers interleukin-6, soluble E-selectin, soluble platelet selectin, angiopoietin-2, soluble intercellular adhesion molecule-1, and von Willebrand factor are not routinely measured in our institution and chest tightness was neither well defined by the publication nor routinely measured in our institution so Falandry et al ( 33 ), Popadic et al ( 28 ), Vassiliou et al ( 31 ), and Wang et al ( 32 ) were not able to be validated.…”

Section: Resultsmentioning

confidence: 99%

External Validation of Prognostic Models in Critical Care: A Cautionary Tale From COVID-19 Pneumonitis

Bate,

Stokes,

Greenlee

et al. 2024

Critical Care Explorations

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OBJECTIVES (BACKGROUND): To externally validate clinical prediction models that aim to predict progression to invasive ventilation or death on the ICU in patients admitted with confirmed COVID-19 pneumonitis. DESIGN: Single-center retrospective external validation study. DATA SOURCES: Routinely collected healthcare data in the ICU electronic patient record. Curated data recorded for each ICU admission for the purposes of the U.K. Intensive Care National Audit and Research Centre (ICNARC). SETTING: The ICU at Manchester Royal Infirmary, Manchester, United Kingdom. PATIENTS: Three hundred forty-nine patients admitted to ICU with confirmed COVID-19 Pneumonitis, older than 18 years, from March 1, 2020, to February 28, 2022. Three hundred two met the inclusion criteria for at least one model. Fifty-five of the 349 patients were admitted before the widespread adoption of dexamethasone for the treatment of severe COVID-19 (pre-dexamethasone patients). OUTCOMES: Ability to be externally validated, discriminate, and calibrate. METHODS: Articles meeting the inclusion criteria were identified, and those that gave sufficient details on predictors used and methods to generate predictions were tested in our cohort of patients, which matched the original publications’ inclusion/exclusion criteria and endpoint. RESULTS: Thirteen clinical prediction articles were identified. There was insufficient information available to validate models in five of the articles; a further three contained predictors that were not routinely measured in our ICU cohort and were not validated; three had performance that was substantially lower than previously published (range C-statistic = 0.483–0.605 in pre-dexamethasone patients and C = 0.494–0.564 among all patients). One model retained its discriminative ability in our cohort compared with previously published results (C = 0.672 and 0.686), and one retained performance among pre-dexamethasone patients but was poor in all patients (C = 0.793 and 0.596). One model could be calibrated but with poor performance. CONCLUSIONS: Our findings, albeit from a single center, suggest that the published performance of COVID-19 prediction models may not be replicated when translated to other institutions. In light of this, we would encourage bedside intensivists to reflect on the role of clinical prediction models in their own clinical decision-making.

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“…Se reporta que la edad, el sexo y las comorbilidades han sido asociados a la gravedad de COVID-19 18 . La edad ha sido reconocida como un determinante importante de la gravedad de COVID-19, se señaló a las personas mayores de 60 años con más posibilidades de ingresar a las unidades de cuidados intensivos y a tener resultados fatales [22][23][24] ; y que los varones 25,26 son más susceptibles que las mujeres a estos riesgos. En el presente estudio cuando comparamos la incidencia de COVID-19 severo según edad y sexo, no se logró encontrar asociación significativa con edad mayor de 50 años, ni con el sexo masculino; algo similar se muestra en los resultados de un estudio en pacientes peruanos fallecidos por COVID-19 donde no se encontró asociación entre la mortalidad por COVID-19 con sexo y edad 27 .…”

Section: Resultsunclassified

Comorbilidad, sexo y edad como condiciones de riesgo para COVID-19 severo en los docentes de una universidad del norte del Perú

Isla-Grados,

Rhor-García Godos,

Puell-Calderón

et al. 2023

spmi

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Introducción: En Perú, la elevada letalidad por COVID-19 demanda identificar desde el nivel comunitario los factores condicionantes de gravedad. Objetivo: Determinar si la comorbilidad, sexo y edad se asocian a la severidad de COVID-19 en docentes universitarios. Material y métodos: Estudio de cohorte prospectivo en 115 docentes que cumplieron criterios de elegibilidad, seguimiento clínico y de laboratorio. Los datos de exposición se obtuvieron a través de un cuestionario en línea y evaluación médica. Se confirmó COVID-19 con resultados de laboratorio y el estado de gravedad mediante entrevista telefónica y visita médica domiciliaria. Se buscó la asociación utilizando el modelo lineal generalizado. Resultados: El 30,43% presentó COVID-19; incidencia: 2 casos contagiados/100 docentes/semana de seguimiento. Se analizó la probabilidad de no contagio por COVID-19, en la semana siete fue del 87,83%, a la semana 24 descendió a 69,57%. La tasa de severidad llegó al 22,9%, más frecuente en varones e hipertensos. Si bien se determinó asociación no significativa entre gravedad de COVID-19 y sexo masculino [IRR=3,65; IC95% (0,45–29,68)], edad mayor de 50 años [IRR=0,56; IC95%(0,14–2,37)], Hipertensión arterial [IRR=1,76; IC95%(0,42–7,38)], Diabetes [IRR=2,36; IC95%(0,29–19,16)] y Obesidad [IRR=0,27; IC95% (0,03–2,22)], el número de participantes no permite afirmarlo. Conclusións: Los datos analizados por ser pocos no permiten señalar que haya asociación significativa entre la comorbilidad, sexo masculino, edad mayor de 50 años y la severidad de COVID-19. Se requiere continuar estudiando estos factores con muestras de mayor tamaño, con la finalidad de reducir la carga enfermedad y/o mortalidad por COVID-19.

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Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19

Cited by 6 publications

References 45 publications

Effect of Cytomegalovirus Reactivation on Inflammatory Status and Mortality of Older COVID-19 Patients

Effect of Cytomegalovirus Reactivation on Inflammatory Status and Mortality of Older COVID-19 Patients

External Validation of Prognostic Models in Critical Care: A Cautionary Tale From COVID-19 Pneumonitis

Comorbilidad, sexo y edad como condiciones de riesgo para COVID-19 severo en los docentes de una universidad del norte del Perú

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