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Serratrice C, Jean M, Herrmann F, di Silvestro K, Trombert V, Moro D, Lacroix O, Coutaz M, Graf C, Zekry D, Mendes A. Long-Term Mortality in Very Old Survivors of COVID-19. J Am Med Dir Assoc 2024:105047. [PMID: 38825322 DOI: 10.1016/j.jamda.2024.105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES This report aimed to describe mortality at 18 months in older survivors of the first wave of COVID-19. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Patients aged ≥65 years hospitalized for COVID-19 in the acute geriatric wards of 2 centers. METHODS Characteristics of deceased and survivors were compared by Fisher exact, Mann-Whitney U, or 2-tailed t tests. Survival rates were analysed by Cox proportional hazards regression models. RESULTS Of a total of 323 patients admitted during the first wave, 196 survived the acute phase, with 34 patients who died in the 18 months after hospital discharge (17.3%). Higher mortality was observed in patients living in nursing homes (P = .033) and in those who were hospitalized after discharge during the follow-up period (97.1% vs 72.8%, P = .001). There was no difference in survival curves according to age, sex, presence of dyspnea, and dementia. Living in a nursing home significantly increased the mortality rates in the multivariate model adjusted for age and sex (hazard ratio 3.07, 95% CI 1.47-6.40; P = .007). CONCLUSIONS AND IMPLICATIONS No excess mortality was observed during 18 months in older survivors of COVID-19. Living in a nursing home was associated with decreased survival rates.
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Affiliation(s)
- Christine Serratrice
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Michèle Jean
- Division of Geriatrics, Hospital of Valais, Martigny, Switzerland
| | - François Herrmann
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Katharine di Silvestro
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Véronique Trombert
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Davide Moro
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Océana Lacroix
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martial Coutaz
- Division of Geriatrics, Hospital of Valais, Martigny, Switzerland
| | - Christophe Graf
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Aline Mendes
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
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Zuin M, Rigatelli G, Bilato MJ, Bilato C, Roncon L. Prevalence of pre-existing peripheral artery disease in COVID-19 patients and relative mortality risk: Systematic review and meta-analysis. Vascular 2023; 31:1103-1109. [PMID: 35593210 PMCID: PMC9127456 DOI: 10.1177/17085381221100380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This study aims to assess prevalence and prognostic implications of pre-existing peripheral artery disease (PAD) in patients infected by the SARS-CoV-2 by means of a systematic review and meta-analysis. MATERIAL AND METHODS We searched MEDLINE and Scopus to locate all the articles published up to 10 December 2021, reporting data on pre-existing PAD among COVID-19 survivors (S) and non survivors (NS). The pooled prevalence of pre-existing PAD in COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. RESULTS Eight investigations, enrolling 13,776 COVID-19 patients (mean age: 67.1 years, 3.863 males), met the inclusion criteria and were included in the final analysis. The pooled prevalence of pre-existing PAD was 5.7% of cases (95% CI: 3.8-8.4%, p < 0.0001), with high heterogeneity (I2 = 84.5%), which was directly correlated with age (p < 0.0001), previous hypertension (p = 0.003), and dyslipidaemia (p = 0.02) as demonstrated by the meta-regression. Moreover, pre-existing PAD was significantly associated with higher risk of short-term death in patients with SARS-CoV-2 infection (OR: 2.78, 95% CI: 2.37-3.27, p < 0.0001 I2 = 0%); the sensitivity analysis confirmed yielded results. CONCLUSIONS Pre-existing PAD represents a comorbidity in about 1 out of 6 COVID-19 patients, but it is associated with a twofold higher risk of short-term mortality.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Marco J Bilato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudio Bilato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Loris Roncon
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
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Conneely M, Leahy S, O’Connor M, Corey G, Gabr A, Saleh A, Okpaje B, O’ Shaughnessy Í, Synnott A, McCarthy A, Holmes A, Robinson K, Ryan L, Griffin A, Barry L, Trépel D, Ryan D, Galvin R. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clin Interv Aging 2023; 18:1769-1788. [PMID: 37901478 PMCID: PMC10612516 DOI: 10.2147/cia.s413961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Anastasia Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Blessing Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Íde O’ Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Alison Holmes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lorna Ryan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
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Tana C, Moffa L, Falasca K, Vecchiet J, Tana M, Mantini C, Ricci F, Ticinesi A, Meschi T, Cipollone F, Giamberardino MA. Approach to COVID-19 in older adults and indications for improving the outcomes. Ann Med 2023; 55:2265298. [PMID: 37839411 PMCID: PMC10578089 DOI: 10.1080/07853890.2023.2265298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023] Open
Abstract
Background: COVID-19 continues to present challenges in the care of older adults with frailty and/or comorbidities and very old patients, who can be hospitalized with severe COVID-19 despite full vaccination. Frailty is a heterogeneous syndrome characterized by an increased aging-related vulnerability due to a reduced physiological reserve and function of systemic organs, and is associated with an impairment of activities of daily living. Frail older adults remain at elevated risk of mortality from COVID-19 compared to older adults without frailty, and some pre-existing risk factors such as malnutrition, prolonged bed rest, and the association with comorbidities can aggravate the SARS-CoV-2 infection. Furthermore, the severity of COVID-19 can impact on long-term functioning of older patients surviving from the infection. Persistent symptoms are another emerging problem of the post-vaccination phase of pandemic, as most patients suffer from chronic symptoms which can become debilitating and affect the daily routine. Aim of this review: In this complex relationship, the evaluation of COVID-19 in vulnerable categories is still a matter of high interest and personalized care plans based on a comprehensive geriatric assessment, tailored interventions; specific therapeutic algorithms among older adults are thus recommended in order to improve the outcomes.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Livia Moffa
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Katia Falasca
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Jacopo Vecchiet
- Infectious Disease Department and COVID-19 Unit, University Hospital of Chieti, Chieti, Italy
| | - Marco Tana
- Internal Medicine Unit, SS. Annunziata Hospital of Chieti, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Italy and Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Italy and Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesco Cipollone
- Medical Clinic, SS. Annunziata Hospital of Chieti, Department of Medicine and Science of Aging, "G. D’Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Maria Adele Giamberardino
- Geriatrics Clinic, SS Annunziata Hospital of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti, Italy
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Camacho-Moll ME, Ramírez-Daher Z, Escobedo-Guajardo BL, Dávila-Valero JC, Rodríguez-de la Garza BL, Bermúdez de León M. ABC-GOALScl score predicts admission to the intensive care unit and mortality of COVID-19 patients over 60 years of age. BMC Geriatr 2023; 23:138. [PMID: 36899318 PMCID: PMC9999052 DOI: 10.1186/s12877-023-03864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND One of the risk factors for getting seriously ill from COVID-19 and reaching high mortality rates is older age. Older age is also associated with comorbidities, which are risk factors for severe COVID-19 infection. Among the tools that have been evaluated to predict intensive care unit (ICU) admission and mortality is ABC-GOALScl. AIM In the present study we validated the utility of ABC-GOALScl to predict in-hospital mortality in subjects over 60 years of age who were positive for SARS-CoV-2 virus at the moment of admission with the purpose of optimizing sanitary resources and offering personalized treatment for these patients. METHODS This was an observational, descriptive, transversal, non-interventional and retrospective study of subjects (≥ 60 years of age), hospitalized due to COVID-19 infection at a general hospital in northeastern Mexico. A logistical regression model was used for data analysis. RESULTS Two hundred forty-three subjects were included in the study, whom 145 (59.7%) passed away, while 98 (40.3%) were discharged. Average age was 71, and 57.6% were male. The prediction model ABC-GOALScl included sex, body mass index, Charlson comorbidity index, dyspnea, arterial pressure, respiratory frequency, SpFi coefficient (Saturation of oxygen/Fraction of inspired oxygen ratio), serum levels of glucose, albumin, and lactate dehydrogenase; all were measured at the moment of admission. The area under the curve for the scale with respect to the variable of discharge due to death was 0.73 (IC 95% = 0.662-0.792). CONCLUSION The ABC-GOALScl scale to predict ICU admission in COVID-19 patients is also useful to predict in-hospital death in COVID-19 patients ≥ 60 years old.
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Affiliation(s)
- María Elena Camacho-Moll
- Department of Molecular Biology, Center for Biomedical Research at Northeast, Mexican Social Security Institute, Calle 2 de abril 501, Col. Independencia, Monterrey, Nuevo Leon, 64720, Mexico.,Center for Molecular Diagnosis and Personalized Medicine, Health Sciences Division, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500-Pte, Zona Valle Poniente, Nuevo Leon, 66238, San Pedro Garza Garcia, Mexico
| | - Zayra Ramírez-Daher
- Residency in Geriatrics, Zone General Hospital No. 4, Mexican Social Security Institute, C. Mariano Matamoros 300, Centro de Guadalupe, Guadalupe, Nuevo Leon, 67100, Mexico
| | - Brenda Leticia Escobedo-Guajardo
- Department of Molecular Biology, Center for Biomedical Research at Northeast, Mexican Social Security Institute, Calle 2 de abril 501, Col. Independencia, Monterrey, Nuevo Leon, 64720, Mexico
| | - Julio César Dávila-Valero
- Residency in Geriatrics, Zone General Hospital No. 4, Mexican Social Security Institute, C. Mariano Matamoros 300, Centro de Guadalupe, Guadalupe, Nuevo Leon, 67100, Mexico
| | - Brenda Ludmila Rodríguez-de la Garza
- Residency in Geriatrics, Zone General Hospital No. 4, Mexican Social Security Institute, C. Mariano Matamoros 300, Centro de Guadalupe, Guadalupe, Nuevo Leon, 67100, Mexico.
| | - Mario Bermúdez de León
- Department of Molecular Biology, Center for Biomedical Research at Northeast, Mexican Social Security Institute, Calle 2 de abril 501, Col. Independencia, Monterrey, Nuevo Leon, 64720, Mexico.
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Sharifi S, Bashirian S, Soltanian A, Khazaei S. Predictors of COVID-19 related death in elderly patients hospitalized due to COVID-19 infection: a cross-sectional study in the west of Iran. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-6. [PMID: 37361295 PMCID: PMC9990002 DOI: 10.1007/s10389-023-01868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
Aim Identifying risk factors associated with mortality in elderly patients hospitalized with COVID-19 can be helpful in managing the disease in this age group. Therefore, the aim of this study was to determine the risk factors of death in elderly patients hospitalized with COVID-19 in Hamadan in 2020. Subject and methods This cross-sectional study was performed on the medical records of 1694 patients aged 60 years and older who were diagnosed with COVID-19 disease between March and August 2020 and were admitted to Shahid Beheshti and Sina Hospitals. A researcher-made checklist included demographic information, clinical information, laboratory results, type of procedures performed for the patient in the hospital, and the number of hospitalization days. Results The results showed that 30% of the elderly patients died due to COVID-19 complications. The results of adapted logistic regression showed that the variables of gender, age, inpatient ward and laboratory indices of albumin, hemoglobin, ESR, and LDH were the main predictors of COVID-19 related death in elderly patients (p < 0.05). Conclusion The rate of COVID-19 related death in the hospitalized elderly patients is remarkable. The death rate increased among male patients, age older than 75 years, hospitalization in the ICU, increased ESR and HDR levels, and decreased albumin and hemoglobin.
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Affiliation(s)
| | - Saeid Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Soltanian
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Clinical factors associated with adverse clinical outcomes in elderly versus non-elderly COVID-19 emergency patients: a multi-center observational study. Int J Emerg Med 2023; 16:11. [PMID: 36814202 PMCID: PMC9944782 DOI: 10.1186/s12245-023-00482-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused over 6 million deaths worldwide. The elderly accounted for a large proportion of patients with their mortality rate largely higher than the non-elderly. However, limited studies have explored clinical factors associated with poor clinical outcomes in this important population. Therefore, this study aimed to determine factors independently associated with adverse clinical outcomes among COVID-19 elderly patients. METHODS We conducted a multicenter observational study at five emergency departments (EDs) in Thailand. Patients over 18 years old diagnosed with COVID-19 between January and December 2021 were included. We classified patients into elderly (age ≥ 65 years) and non-elderly (age < 65 years). The primary clinical outcome was in-hospital mortality. The secondary outcomes were endotracheal intubation and intensive care unit admission. We identified independent factors associating with these outcomes both in the whole population and separately by age group using multivariate logistic regression models. RESULTS A total of 978 patients were included, 519 (53.1%) were elderly and 459 (46.9%) were non-elderly, and 254 (26%) died at hospital discharge. The mortality rate was significantly higher in the elderly group (39.1% versus 14.3%, p<0.001)). In the elderly, age (adjusted odds ratio (aOR) 1.13; 95% confidence interval (CI) 1.1-1.2; p<0.001), male sex (aOR 3.64; 95%CI 1.5-8.8; p=0.004), do-not-resuscitate (DNR) status (aOR 12.46; 95%CI 3.8-40.7; p<0.001), diastolic blood pressure (aOR 0.96; 95%CI 0.9-1.0; p=0.002), body temperature (aOR 1.74; 95%CI 1.0-2.9; p=0.036), and Glasgow Coma Scale (GCS) score (aOR 0.71; 95%CI 0.5-1.0; p=0.026) were independent baseline and physiologic factors associated with in-hospital mortality. Only DNR status and GCS score were associated with in-hospital mortality in both the elderly and non-elderly, as well as the overall population. Lower total bilirubin was independently associated with in-hospital mortality in the elderly (aOR 0.34; 95%CI 0.1-0.9; p=0.035), while a higher level was associated with the outcome in the non-elderly. C-reactive protein (CRP) was the only laboratory factor independently associated with all three study outcomes in the elderly (aOR for in-hospital mortality 1.01; 95%CI 1.0-1.0; p=0.006). CONCLUSION Important clinical factors associated with in-hospital mortality in elderly COVID-19 patients were age, sex, DNR status, diastolic blood pressure, body temperature, GCS score, total bilirubin, and CRP. These parameters may aid in triage and ED disposition decision-making in this very important patient population during times of limited resources during the COVID-19 pandemic.
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Pilotto A, Custodero C, Palmer K, Sanchez-Garcia EM, Topinkova E, Polidori MC. A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS). Eur Geriatr Med 2023; 14:33-41. [PMID: 36656486 PMCID: PMC9851592 DOI: 10.1007/s41999-022-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Katie Palmer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective. Eur Geriatr Med 2023; 14:43-50. [PMID: 36477605 PMCID: PMC9735039 DOI: 10.1007/s41999-022-00721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. METHODS Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. RESULTS Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. CONCLUSION This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.
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Crook H, Ramirez A, Hosseini AA, Vavougyios G, Lehmann C, Bruchfeld J, Schneider A, d'Avossa G, Lo Re V, Salmoiraghi A, Mukaetova-Ladinska E, Katshu M, Boneschi FM, Håkansson K, Geerlings M, Pracht E, Ruiz A, Jansen JF, Snyder H, Kivipelto M, Edison P. European Working Group on SARS-CoV-2: Current Understanding, Unknowns, and Recommendations on the Neurological Complications of COVID-19. Brain Connect 2023; 13:178-210. [PMID: 36719785 DOI: 10.1089/brain.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The emergence of COVID-19 was rapidly followed by infection and the deaths of millions of people across the globe. With much of the research and scientific advancement rightly focused on reducing the burden of severe and critical acute COVID-19 infection, the long-term effects endured by those who survived the acute infection has been previously overlooked. Now, an appreciation for the post-COVID-19 condition, including its neurological manifestations, is growing, although there remain many unknowns regarding the aetiology and risk factors of the condition, as well as how to effectively diagnose and treat it. Here, drawing upon the experiences and expertise of the clinicians and academics of the European working group on COVID-19, we have reviewed the current literature to provide a comprehensive overview of the neurological sequalae of the post-COVID-19 condition. In this review, we provide a summary of the neurological symptoms associated with the post-COVID-19 condition, before discussing the possible mechanisms which may underly and manifest these symptoms. Following this, we explore the risk factors for developing neurological symptoms as a result of COVID-19 and the post-COVID-19 condition, as well as how COVID-19 infection may itself be a risk factor for the development of neurological disease in the future. Lastly, we evaluate how the post-COVID condition could be accurately diagnosed and effectively treated, including examples of the current guidelines, clinical outcomes and tools that have been developed to aid in this process, as well as addressing the protection provided by COVID-19 vaccines against post-COVID-19 condition. Overall, this review provides a comprehensive overview of the neurological sequalae of the post-COVID-19 condition.
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Affiliation(s)
- Harry Crook
- Imperial College London, 4615, Brain Sciences, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Alfredo Ramirez
- University of Cologne, 14309, Department of Psychiatry and Psychotherapy, Koln, Nordrhein-Westfalen, Germany
- University of Bonn, 9374, Department of Neurodegenerative diseases and Geriatric Psychiatry, Bonn, Nordrhein-Westfalen, Germany
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Department of Psychiatry , San Antonio, Texas, United States
- German Centre for Neurodegenerative Diseases, 172279, Bonn, Nordrhein-Westfalen, Germany;
| | - Akram A Hosseini
- Nottingham University Hospitals NHS Trust, 9820, Department of Neurology, Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland;
| | - Georgios Vavougyios
- University of Cyprus, 54557, Department of Neurology, Nicosia, Nicosia, Cyprus;
| | - Clara Lehmann
- University of Cologne, 14309, Department of Internal Medicine, Koln, Nordrhein-Westfalen, Germany
- University of Cologne, 14309, Center for Molecular Medicine Cologne (CMMC), Koln, Nordrhein-Westfalen, Germany
- German Centre for Infection Research, 459706, Braunschweig, Niedersachsen, Germany;
| | - Judith Bruchfeld
- Karolinska University Hospital, 59562, Department of Infectious Diseases, Stockholm, Sweden;
| | - Anja Schneider
- University Hospital Bonn, 39062, Department of Neurodegenerative diseases and Geriatric Psychiatry, Bonn, Nordrhein-Westfalen, Germany
- German Centre for Neurodegenerative Diseases, 172279, Bonn, Nordrhein-Westfalen, Germany;
| | - Giovanni d'Avossa
- Bangor University, 1506, School of Psychology, Bangor, Gwynedd, United Kingdom of Great Britain and Northern Ireland;
| | | | - Alberto Salmoiraghi
- Betsi Cadwaladr University Health Board, 1507, Bangor, Gwynedd, United Kingdom of Great Britain and Northern Ireland
- Glyndwr University, 8725, Wrexham, Clwyd, United Kingdom of Great Britain and Northern Ireland;
| | - Elizabeta Mukaetova-Ladinska
- University of Leicester, 4488, Neuroscience, Psychology and Behaviour, University Road, Leicester, United Kingdom of Great Britain and Northern Ireland, LE1 7RH;
| | - Mohammad Katshu
- University of Nottingham, 6123, School of Medicine, Nottingham, Nottinghamshire, United Kingdom of Great Britain and Northern Ireland;
| | - Filippo M Boneschi
- University of Milan, 9304, Division of Neuroscience and INSPE, San Raffaele Scientific Institute, Milano, Lombardia, Italy;
| | - Krister Håkansson
- Karolinska Institute, 27106, Department of Neurobiology, Care Sciences and Society, Stockholm, Stockholm, Sweden;
| | - Mirjam Geerlings
- Utrecht University, 8125, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands;
| | - Elisabeth Pracht
- University of Cologne, 14309, Department of Psychiatry and Psychotherapy, Koln, Nordrhein-Westfalen, Germany;
| | - Agustín Ruiz
- Universitat Internacional de Catalunya, 16760, Institut Català de Neurociències Aplicades, Barcelona, Catalunya, Spain;
| | - Jacobus Fa Jansen
- Maastricht University Medical Centre+, 199236, Department of Radiology and Nuclear Medicine, Maastricht, Limburg, Netherlands;
| | - Heather Snyder
- Alzheimer's Association, 44027, Chicago, Illinois, United States;
| | - Miia Kivipelto
- Karolinska Institute, 27106, Department of Neurobiology, Care Sciences and Society, Stockholm, Stockholm, Sweden;
| | - Paul Edison
- Imperial College London, 4615, Brain Sciences, Neurology Imaging Unit, 1st Floor, B - Block, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom of Great Britain and Northern Ireland, SW7 2AZ;
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Patanavanich R, Siripoon T, Amponnavarat S, Glantz SA. Active Smokers Are at Higher Risk of COVID-19 Death: A Systematic Review and Meta-analysis. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2023; 25:177-184. [PMID: 35363877 DOI: 10.1093/ntr/ntac085] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/08/2022] [Accepted: 03/29/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Current evidence indicates that smoking worsens COVID-19 outcomes. However, when studies restricted their analyses to current smokers, the risks for COVID-19 severity and death are inconsistent. AIMS AND METHODS This meta-analysis explored the association between current smoking and the risk for mortality based on the studies that reported all three categories of smoking (current, former, and never smokers) to overcome the limitation of the previous meta-analyses which former smokers might have been classified as nonsmokers. We searched PubMed and Embase up to January 1, 2021. We included studies reporting all three categories of smoking behaviors of COVID-19 patients and mortality outcomes. A random-effects meta-analysis and meta-regression were used to examine relationships in the data. RESULTS A total of 34 articles with 35 193 COVID-19 patients was included. The meta-analysis confirmed the association between current smoking (odds ratio [OR] 1.26, 95% confidence interval [CI]: 1.01-1.58) and former smoking (OR 1.76, 95% CI: 1.53-2.03) with COVID-19 mortality. We also found that the risk for COVID-19 death in current smokers does not vary by age, but significantly drops by age in former smokers. Moreover, current smokers in non-high-income countries have higher risks of COVID-19 death compared with high-income countries (OR 3.11, 95% CI: 2.04-4.72 vs. OR 1.14, 95% CI: 0.91-1.43; p = .015). CONCLUSIONS Current and former smokers are at higher risk of dying from COVID-19. Tobacco control should be strengthened to encourage current smokers to quit and prevent the initiation of smoking. Public health professionals should take the COVID-19 pandemic as an opportunity to promote smoking prevention and cession. IMPLICATIONS This study makes an important contribution to the existing literature by distinguishing between current and former smoking and their separate effects on COVID-19 mortality. We also explore the effects by age of patients and country income level. Findings from this study provide empirical evidence against misinformation about the relationship between smoking and COVID-19 mortality.
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Affiliation(s)
- Roengrudee Patanavanich
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanatorn Siripoon
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Salin Amponnavarat
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Stanton A Glantz
- Center for Tobacco Control Research and Education (retired), University of California San Francisco, San Francisco, CA, USA
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12
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Esmaeili ED, Azizi H, Sarbazi E, Khodamoradi F. The global case fatality rate due to COVID-19 in hospitalized elderly patients by sex, year, gross domestic product, and continent: A systematic review, meta-analysis, and meta-regression. New Microbes New Infect 2023; 51:101079. [PMID: 36618974 PMCID: PMC9811917 DOI: 10.1016/j.nmni.2022.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/25/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Background Although elderly people are at a huge risk of mortality due to COVID-19, the Case Fatality Rate (CFR) in hospitalized elderly patients is poorly investigated. This meta-analysis and meta-regression aimed to generate pooled CFR due to COVID-19 in hospitalized elderly patients by sex, Gross Domestic Product (GDP), year, and continent and also to explain the potential source of the heterogeneity and variations in the pooled estimation of COVID-19 CFR. Methods We systematically searched PubMed, Scopus, Web of Science, CINAHL, and Embase up to 31 July 2022. Eligibility assessment of records was performed independently in a blinded, standardized way by two reviewers. Meta-analysis and Meta-regression analysis were carried out to estimate pooled CFR and the potential sources of the heterogeneity. Results The study included 5683 confirmed hospitalized elderly COVID-19 patients, 1809 deaths, and 19 original articles from 10 countries. The pooled estimate of the overall CFR, and by male and female sexes were 29%, 34%, and 24%, respectively. We found CFR was decreased by increasing female sex proportion, GDP, and year of publication. Multivariate meta-regression analysis indicated that the age and sex of patients, continent, GDP, and year of the publication together explained the majority of the heterogeneity and variations in the pooled estimate of the hospitalized elderly COVID-19 CFR. Conclusions This review provided reliable pooled CFR measures for hospitalized elderly patients with COVID-19. Although COVID-19 fatality has decreased in hospitalized elderly patients over time, it is still high in hospitalized elderly patients and needs advanced treatment support.
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Affiliation(s)
- Elham Davtalab Esmaeili
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author. Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ehsan Sarbazi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Khodamoradi
- Department of Social Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Aguirre-Milachay E, León-Figueroa DA, Chumán-Sánchez M, Romani L, Runzer-Colmenares FM. Factors associated with mortality in patients hospitalized for COVID-19 admitted to a tertiary hospital in Lambayeque, Peru, during the first wave of the pandemic. PLoS One 2023; 18:e0285133. [PMID: 37167338 PMCID: PMC10174592 DOI: 10.1371/journal.pone.0285133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/15/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide, becoming a long-term pandemic. OBJECTIVES To analyze the factors associated with mortality in patients hospitalized for COVID-19 in a tertiary hospital in the Lambayeque region of Peru. METHODS A retrospective cohort study of patients with a diagnosis of COVID-19, hospitalized in a hospital in northern Peru, was conducted from March to September 2020. RESULTS Of the 297 patients studied, 69% were women, the mean age was 63.99 years (SD = ±15.33 years). Hypertension was the most frequent comorbidity (36.67%), followed by diabetes mellitus (24.67%) and obesity (8.33%). The probability of survival at 3 days of ICU stay was 65.3%, at 7 days 24.2%, and 0% on day 14. Risk factors associated with mortality in patients hospitalized for COVID-19 are age, male sex, tachypnea, low systolic blood pressure, low peripheral oxygen saturation, impaired renal function, elevated IL-6 and elevated D-dimer. CONCLUSIONS Mortality in hospitalized patients with COVID-19 was 51.18 per 100 persons, Mortality was found to be associated with hypertension, type of infiltrating, and sepsis.
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Affiliation(s)
- Edwin Aguirre-Milachay
- Servicio de Geriatría, Departamento de Medicina, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
| | - Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marisella Chumán-Sánchez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Perú
| | - Luccio Romani
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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14
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Lee YK, Motwani Y, Brook J, Martin E, Seligman B, Schaenman J. Predictors of COVID-19 outcomes: Interplay of frailty, comorbidity, and age in COVID-19 prognosis. Medicine (Baltimore) 2022; 101:e32343. [PMID: 36595791 PMCID: PMC9794263 DOI: 10.1097/md.0000000000032343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prior research has identified frailty, comorbidity, and age as predictors of outcomes for patients with coronavirus disease 2019 (COVID-19), including mortality. However, it remains unclear how these factors play different roles in COVID-19 prognosis. This study focused on correlations between frailty, comorbidity and age, and their correlations to discharge outcome and length-of-stay in hospitalized patients with COVID-19. Clinical data was collected from 56 patients who were ≥50 years old and admitted from March 2020 to June 2020 primarily for COVID-19. Frailty Risk Score (FRS) and the Charlson Comorbidity Index (CCI) were used for assessment of frailty and comorbidity burden, respectively. Age had significant positive correlation with FRS and CCI (P < .001, P < .001, respectively). There was also significant positive correlation between FRS and CCI (P < .001). For mortality, patients who died during their hospitalization had significantly higher FRS and CCI (P = .01 and P < .001, respectively) but were not significantly older than patients who did not. FRS, CCI, and age were all significantly associated when looking at overall adverse discharge outcome (transfer to other facility or death) (P < .001, P = .005, and P = .009, respectively). However, none of the 3 variables were significantly correlated with length-of-stay. Multivariate analysis showed FRS (P = .007) but not patient age (P = .967) was significantly associated with death. We find that frailty is associated with adverse outcomes from COVID-19 and supplants age in multivariable analysis. Frailty should be part of risk assessment of older adults with COVID-19.
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Affiliation(s)
- Yoon Kyung Lee
- UCLA David Geffen School of Medicine, Los Angeles, CA
- * Correspondence: Yoon Kyung Lee, UCLA David Geffen School of Medicine, Los Angeles, CA 90024 (e-mail: )
| | - Yash Motwani
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Jenny Brook
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Emily Martin
- UCLA Division of Infectious Diseases, Los Angeles, CA
| | - Benjamin Seligman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- West LA VA Geriatric Medicine, Los Angeles, CA
| | - Joanna Schaenman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- UCLA Division of Infectious Diseases, Los Angeles, CA
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15
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Oliván-Blázquez B, Bartolomé-Moreno C, Gericó-Aseguinolaza J, Méndez-López F, Lerma-Irureta D, Lamiquiz-Moneo I, Fernández-Martínez S, Magallón-Botaya R. Relationship between initial symptoms and the prognosis, sex, and demographic area of patients with COVID-19. Front Med (Lausanne) 2022; 9:1040062. [PMID: 36590935 PMCID: PMC9795186 DOI: 10.3389/fmed.2022.1040062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background A method of determining the initial symptoms and main prognostic identifiers for COVID-19 can be a key tool for physicians, especially primary care physicians. Therefore, the objective of this study was to examine the prognosis of patients with COVID-19 from two different demographic regions according to baseline and main symptoms, age, and sex. Methods All individuals selected from both urban and rural health centers were over 18 years of age, had COVID-19 before 2 March 2021, and were followed up with a primary care physician. All patients included in this study were recruited in terms of sex, age at the time of infection, type of contact, baseline symptoms, primary and secondary symptomatology, emergency assistance, hospitalization, intensive care unit (ICU) admission, and death. Results A total of 219 and 214 subjects were recruited from rural and urban health centers, respectively. Subjects with COVID-19 from rural areas were significantly older in age, with a higher proportion of men, and had significantly lower baseline and main symptoms than those from urban areas. In addition, the presence of both fever and dyspnea as the initial or main symptom is significantly associated with emergency assistance, hospitalization, and death, regardless of sex, age, and demographic area. This type of illness was reported to be significantly less frequent in the rural population than in the urban population. Conclusion The presence of both fever and dyspnea as both initial and main symptoms is a poor prognostic factor for COVID-19, regardless of age, sex, and demographic areas. In addition, women reported lower levels of fever and dyspnea, requiring minimal emergency assistance and fewer hospitalization, and a lower rate of mortality than men. During a COVID-19 infection follow-up, subjects in rural areas seem to have less access to medical care than those in urban areas.
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Affiliation(s)
- Bárbara Oliván-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain,Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Cruz Bartolomé-Moreno
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Aragonese Healthcare Service, Zaragoza, Spain,Aragonese Healthcare Service, Department of Family and Community Care Teaching- Sector I, Zaragoza, Spain,*Correspondence: Cruz Bartolomé-Moreno
| | | | - Fátima Méndez-López
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - David Lerma-Irureta
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Itziar Lamiquiz-Moneo
- Miguel Servet University Hospital, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | - Rosa Magallón-Botaya
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain,Aragonese Healthcare Service, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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16
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Corna S, Giardini M, Godi M, Bellotti L, Arcolin I. Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16383. [PMID: 36554262 PMCID: PMC9778393 DOI: 10.3390/ijerph192416383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Many clinical practice recommendations indicate rehabilitation as essential for patients with sequelae of severe or critical COVID-19 and suggest the prompt initiation of a multicomponent rehabilitation program focused on aerobic and endurance training. However, randomized controlled trials (RCTs) regarding aerobic exercise are lacking. Therefore, we aimed to assess the feasibility and effectiveness of the addition of aerobic training to standard rehabilitation in subjects with subacute COVID-19. Participants were 32/214 patients with the sequelae of severe or critical COVID-19 in the acute phase who were eligible and agreed to participate in the study (eligibility = 15%, recruitment = 100%). After randomization and assessment with functional and strength tests, all the participants underwent an inpatient-tailored rehabilitation program (50 min/day, 5 days/week, 10 sessions); in addition, the experimental group performed a low- to moderate-intensity aerobic exercise (30 min/day, 10 sessions). No dropouts or severe adverse events were reported, with an attendance rate of 95.6%. Most of the secondary outcomes significantly improved in both groups, but the improvement in the Functional Independence Measure and Cumulated Ambulation Score-Italian version was significantly greater in the experimental group (at least, p < 0.05). This RCT showed that aerobic exercise is feasible and safe in subacute COVID-19. Moreover, it appears to be beneficial and useful in improving patients' independence and mobility.
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17
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Nguyen-Michel VH, Houot M, Delorme C, Sangaré A, Gales A, Frazzini V, Hanin A, Aissani D, Trân T, Oquendo B, Ketz F, Lafuente-Lafuente C, Oasi C, Kinugawa K, Ouvrard G, Ursu R, Degos B, Rohaut B, Demeret S, Lambrecq V, Navarro V, Fournier E, Corvol JC, Borden A. Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality. Brain Behav 2022; 12:e2787. [PMID: 36355411 PMCID: PMC9759137 DOI: 10.1002/brb3.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/05/2022] [Accepted: 09/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions. METHODS We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19. RESULTS Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001). CONCLUSION Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.
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Affiliation(s)
- Vi-Huong Nguyen-Michel
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France
| | - Marion Houot
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Center of Excellence of Neurodegenerative Disease (CoEN), Paris, France
| | - Cécile Delorme
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Aude Sangaré
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Ana Gales
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Sleep Disorders Unit, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Djamal Aissani
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Department of Radiology, Paris, France
| | - Thanh Trân
- Pierre Bérégovoy Hospital, Neurological Unit, Nevers, France
| | - Bruno Oquendo
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Flora Ketz
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | | | - Christel Oasi
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Kiyoka Kinugawa
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, CNRS, UMR 8256 Biological Adaption and Aging, Paris, France
| | - Gaëlle Ouvrard
- Sorbonne Université, AP-HP, Rothschild Hospital, Neurological Rehabilitation Unit, Paris, France
| | - Renata Ursu
- Université de Paris, AP-HP Nord, Saint-Louis Hospital, Neurological Unit, Paris, France
| | - Bertrand Degos
- Sorbonne Université Paris Nord, AP-HP, Avicenne Hospital, Department of Neurology, Bobigny, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Sophie Demeret
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Vincent Navarro
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Emmanuel Fournier
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Alaina Borden
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France
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18
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Mendes A, Serratrice C, Herrmann FR, Gold G, Graf CE, Zekry D, Genton L. Nutritional risk at hospital admission is associated with prolonged length of hospital stay in old patients with COVID-19. Clin Nutr 2022; 41:3085-3088. [PMID: 33933295 PMCID: PMC7985608 DOI: 10.1016/j.clnu.2021.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS To investigate the association of nutritional risk at admission with the length of hospital stay (LOS) and mortality in older patients with COVID-19. METHODS Retrospective monocentric study in an acute geriatric hospital. Data were collected after an extensive review of medical records and the nutritional risk was assessed according to the Nutritional Risk Screening (NRS). Univariate and multivariate (adjusted for age, sex and comorbidity burden) Cox proportional-hazard and linear regression models were used to investigate the association with the above-mentioned outcomes. RESULTS Of a total of 245 patients (86.1 ± 6.4 yrs), 50.6% had a severe nutritional risk with an NRS≥5/7 at admission. Lower BMI, cognitive impairment and swallowing disorders were more prevalent in the patients with a higher NRS. A NRS≥5 was not associated with mortality but prolonged by more than 3 days the LOS among the 173 survivors (β 3.69; 0.71-6.67 95% CI; p = 0.016), with a discharge rate delayed by 1.8 times (HR 0.55; 0.37-0.83 95% CI; p = 0.101). CONCLUSION Among the survivors of COVID-19 in an acute geriatric hospital, a NRS ≥5 at admission was associated with a longer LOS, but not with mortality.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland,Corresponding author. Chemin du Pont-Bochet 3, Thônex, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
| | - François R. Herrmann
- Division of Geriatrics, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
| | - Christophe E. Graf
- Division of Internal Medicine and Rehabilitation, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland
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19
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Tredinnick-Rowe J, Symonds R. Rapid systematic review of respiratory rate as a vital sign of clinical deterioration in COVID-19. Expert Rev Respir Med 2022; 16:1227-1236. [PMID: 36644851 DOI: 10.1080/17476348.2023.2169138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This meta-analysis aimed to establish a clinical evidence base for respiratory rate (RR) as a single predictor of early-onset COVID-19. The review also looked to determine the practical implementation of mobile respiratory rate measuring devices where information was available. METHODS We focused on domestic settings with older adults. Relevant studies were identified through MEDLINE, Embase, and CENTRAL databases. A snowballing method was also used. Articles published from the beginning of the COVID-19 pandemic (2019) until Feb 2022 were selected. Databases were searched for terms related to COVID-19 and respiratory rate measurements in domestic patients. RESULTS A total of 2,889 articles were screened for relevant content, of which 60 full-text publications were included. We compared the Odds Ratios and statistically significant results of both vital signs. CONCLUSION Multinational studies across dozens of countries have shown respiratory rate to have predictive accuracy in detecting COVID-19 deterioration. However, considerable variability is present in the data, making it harder to be sure about the effects. There is no meaningful difference in data quality in terms of variability (95% CI intervals) between vital signs as predictors of decline in COVID-19 patients. Contextual and economic factors will likely determine the choice of measurement used.
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20
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Sonaglioni A, Lombardo M, Albini A, Noonan DM, Re M, Cassandro R, Elia D, Caminati A, Nicolosi GL, Harari S. Charlson comorbidity index, neutrophil-to-lymphocyte ratio and undertreatment with renin-angiotensin-aldosterone system inhibitors predict in-hospital mortality of hospitalized COVID-19 patients during the omicron dominant period. Front Immunol 2022; 13:958418. [PMID: 36090992 PMCID: PMC9453812 DOI: 10.3389/fimmu.2022.958418] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical predictors of in-hospital mortality in hospitalized patients with Coronavirus disease 2019 (COVID-19) infection during the Omicron period. Methods All consecutive hospitalized laboratory‐confirmed COVID-19 patients between January and May 2022 were retrospectively analyzed. All patients underwent accurate physical, laboratory, radiographic and echocardiographic examination. Primary endpoint was in-hospital mortality. Results 74 consecutive COVID-19 patients (80.0 ± 12.6 yrs, 45.9% males) were included. Patients who died during hospitalization (27%) and those who were discharged alive (73%) were separately analyzed. Compared to patients discharged alive, those who died were significantly older, with higher comorbidity burden and greater prevalence of laboratory, radiographic and echographic signs of pulmonary and systemic congestion. Charlson comorbidity index (CCI) (OR 1.76, 95%CI 1.07-2.92), neutrophil-to-lymphocyte ratio (NLR) (OR 1.24, 95%CI 1.10-1.39) and absence of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs) therapy (OR 0.01, 95%CI 0.00-0.22) independently predicted the primary endpoint. CCI ≥7 and NLR ≥9 were the best cut-off values for predicting mortality. The mortality risk for patients with CCI ≥7, NLR ≥9 and not in ACEI/ARBs therapy was high (86%); for patients with CCI <7, NLR ≥9, with (16.6%) or without (25%) ACEI/ARBs therapy was intermediate; for patients with CCI <7, NLR <9 and in ACEI/ARBs therapy was of 0%. Conclusions High comorbidity burden, high levels of NLR and the undertreatment with ACEI/ARBs were the main prognostic indicators of in-hospital mortality. The risk stratification of COVID-19 patients at hospital admission would help the clinicians to take care of the high-risk patients and reduce the mortality.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Adriana Albini
- European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Adriana Albini,
| | - Douglas M. Noonan
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Unit of Molecular Pathology, Immunology and Biochemistry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Margherita Re
- Division of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Roberto Cassandro
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Davide Elia
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Antonella Caminati
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | | | - Sergio Harari
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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21
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Veterovska-Miljkovic L, Ljatif-Petrusovska S, Jordanovski L, Ivanovska M, Bundaleska O, Brezovska E, Zdraveska N, Velkova E. Clinical Features and Analysis of Survival in a Sample of Patients Infected with SARS-COV-2 in the Specialized Hospital for Geriatric and Palliative Medicine “November 13” – Skopje. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: New worldwide intensive studies of a new virus called severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) have shown that in its clinical manifestations, the virus has an extremely different expression in different population groups, with age being found to be one of the most common and significant variables.
AIM: The objective of this study is to categorize the difference between clinical and laboratory parameters of a sample of patients infected with SARS-COV-2 in the Specialized Hospital for Geriatric and Palliative Medicine “November 13” – Skopje, between survived and deceased patients, impact on the number and severity of comorbidities on the severity of the clinical picture and the survival rate.
MATERIALS AND METHODS: In our study, we analyzed data from a sample of 113 patients hospitalized in our institution. The study is cross-sectional and observational, and in the methodology, we analyzed demographic data by gender and age groups, analysis of comorbidities, functional and nutritional status of patients, and risk factors for mortality and survival rate. For this purpose, we used several geriatric scores: Cumulative Illness Rating Scale scale–Geriatric (CIRS-G), degree of functional ability (Bartel), and the Geriatric Nutritional Index (GNRI) score.
RESULTS: The deceased patients had a significantly higher CIRS-G score, while no significant difference in functional (Bartel) and GNRI scores was found. Multivariate regression analysis showed that lymphocytopenia and low saturation were high-risk factors for death in the geriatric population.
CONCLUSION: Providing hospital-level care for the elderly with SARS-COV-2 contributes to a lower mortality rate.
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22
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Zuin M, Rigatelli G, Bilato C, Rigatelli A, Roncon L, Ribichini F. Preexisting coronary artery disease among coronavirus disease 2019 patients: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2022; 23:535-545. [PMID: 35905000 DOI: 10.2459/jcm.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The prevalence and prognostic implications of coronary artery disease (CAD) in patients infected by the novel coronavirus 2019 (COVID-19) disease remain unclear. METHODS We conducted a systematic review and meta-analysis to investigate the prevalence and mortality risk in COVID-19 patients with preexisting CAD. We searched Medline and Scopus to locate all articles published up to December 8, 2021, reporting data of COVID-19 survivors and nonsurvivors with preexisting CAD. Data were pooled using the Mantel-Haenszel random effects models with odds ratio (OR) as the effect measure with the related 95% confidence interval (CI). RESULTS Thirty-eight studies including 27 435 patients (mean age 61.5 and 70.9 years) were analysed. The pooled prevalence of preexisting CAD was 12.6% (95% CI: 11.2-16.5%, I2 : 95.6%), and resulted as higher in intensive care unit patients (17.5%, 95% CI: 11.9-25.1, I2 : 88.4%) and in European cohorts (13.1%, 95% CI: 7.8-21.6%, P < 0.001, I2 : 98.4%). COVID-19 patients with preexisting CAD had a two-fold risk of short-term mortality (OR 2.61, 95% CI 2.10-3.24, P < 0.001, I2 = 73.6%); this risk was higher among Asian cohorts (OR: 2.66, 95% CI: 1.79-3.90, P < 0.001, I2 : 77.3%) compared with European (OR: 2.44, 95% CI: 1.90-3.14, P < 0.001, I2 : 56.9%) and American (OR: 1.86, 95% CI: 1.41-2.44, P < 0.001, I2 : 0%) populations. The association between CAD and poor short-term prognosis was influenced by age, prevalence of hypertension (HT), DM and CKD. CONCLUSIONS Preexisting CAD is present in approximately 1 in 10 patients hospitalized for COVID-19 and significantly associated with an increased risk of short-term mortality, which is influenced by age, HT, DM and CKD.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo
| | - Flavio Ribichini
- Institute of Cardiology, University of Verona School of Medicine, Verona, Italy
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23
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Kim KM, Evans DS, Jacobson J, Jiang X, Browner W, Cummings SR. Rapid prediction of in-hospital mortality among adults with COVID-19 disease. PLoS One 2022; 17:e0269813. [PMID: 35905072 PMCID: PMC9337639 DOI: 10.1371/journal.pone.0269813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We developed a simple tool to estimate the probability of dying from acute COVID-19 illness only with readily available assessments at initial admission. METHODS This retrospective study included 13,190 racially and ethnically diverse adults admitted to one of the New York City Health + Hospitals (NYC H+H) system for COVID-19 illness between March 1 and June 30, 2020. Demographic characteristics, simple vital signs and routine clinical laboratory tests were collected from the electronic medical records. A clinical prediction model to estimate the risk of dying during the hospitalization were developed. RESULTS Mean age (interquartile range) was 58 (45-72) years; 5421 (41%) were women, 5258 were Latinx (40%), 3805 Black (29%), 1168 White (9%), and 2959 Other (22%). During hospitalization, 2,875 were (22%) died. Using separate test and validation samples, machine learning (Gradient Boosted Decision Trees) identified eight variables-oxygen saturation, respiratory rate, systolic and diastolic blood pressures, pulse rate, blood urea nitrogen level, age and creatinine-that predicted mortality, with an area under the ROC curve (AUC) of 94%. A score based on these variables classified 5,677 (46%) as low risk (a score of 0) who had 0.8% (95% confidence interval, 0.5-1.0%) risk of dying, and 674 (5.4%) as high-risk (score ≥ 12 points) who had a 97.6% (96.5-98.8%) risk of dying; the remainder had intermediate risks. A risk calculator is available online at https://danielevanslab.shinyapps.io/Covid_mortality/. CONCLUSIONS In a diverse population of hospitalized patients with COVID-19 illness, a clinical prediction model using a few readily available vital signs reflecting the severity of disease may precisely predict in-hospital mortality in diverse populations and can rapidly assist decisions to prioritize admissions and intensive care.
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Affiliation(s)
- Kyoung Min Kim
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, Sutter Health, San Francisco, California, United States of America
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Daniel S. Evans
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, Sutter Health, San Francisco, California, United States of America
| | - Jessica Jacobson
- New York City Health + Hospitals/Bellevue-NYU Grossman School of Medicine, New York, New York, United States of America
| | - Xiaqing Jiang
- Orthopedic Surgery, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Warren Browner
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, Sutter Health, San Francisco, California, United States of America
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, Sutter Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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24
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Decreased Levels of SARS-CoV-2 Fusion-Inhibitory Antibodies in the Serum of Aged COVID-19 Patients. Diagnostics (Basel) 2022; 12:diagnostics12081813. [PMID: 36010162 PMCID: PMC9406670 DOI: 10.3390/diagnostics12081813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The SARS-CoV-2 pandemic was particularly devastating for elderly people, and the underlying mechanisms of the disease are still poorly understood. In this study, we investigated fusion inhibitory antibodies (fiAbs) in elderly and younger COVID-19 patients and analyzed predictive factors for their occurrence. Methods: Data and samples were collected in two cohorts of hospitalized patients. A fusion assay of SARS-CoV-2 spike-expressing cells with ACE2-expressing cells was used to quantify fiAbs in the serum of patients. Results: A total of 108 patients (52 elderly (mean age 85 ± 7 years); 56 young (mean age 52 ± 10 years)) were studied. The concentrations of fiAbs were lower in geriatric patients, as evidenced at high serum dilutions (1/512). The association between fiAbs and anti-Spike Ig levels was weak (correlation coefficient < 0.3), but statistically significant. Variables associated with fusion were the delay between the onset of symptoms and testing (HR = −2.69; p < 0.001), clinical frailty scale (HR = 4.71; p = 0.035), and WHO severity score (HR = −6.01, p = 0.048). Conclusions: Elderly patients had lower fiAbs levels after COVID-19 infection. The decreased fiAbs levels were associated with frailty.
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25
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Chang AY, Babb KN. One-Year Report of COVID-19 Impact on Geriatric Patients: a Bio-Psycho-Social Approach. Can Geriatr J 2022; 25:212-221. [PMID: 35747408 PMCID: PMC9156418 DOI: 10.5770/cgj.25.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness. Method We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric population between December 2019 and April 2021, a total of 748 articles. Results The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism. Conclusion This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.
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26
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Prendki V, Tiseo G, Falcone M. Caring for older adults during the COVID-19 pandemic. Clin Microbiol Infect 2022; 28:785-791. [PMID: 35283306 PMCID: PMC8912971 DOI: 10.1016/j.cmi.2022.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist. OBJECTIVES To discuss unmet needs of COVID-19 in this special population. SOURCES A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide the literature search. The search was conducted in the MEDLINE database, combining specific search terms. Two reviewers independently conducted the search and selected the studies according to the prespecified clinical questions. CONTENT Elderly patients with COVID-19 have peculiar characteristics. They may have atypical clinical presentation, with no fever and with delirium or neurological manifestations as the most common signs, with potential delayed diagnosis and increased risk of death. The reported fatality rates among elderly patients with COVID-19 are extremely high. Several factors, including comorbidities, atypical presentation, and exclusion from intensive care unit care, contribute to this excess of mortality. Age alone is frequently used as a key factor to exclude the elderly from intensive care, but there is evidence that frailty rather than age better predicts the risk of poor outcome in this category. Durability of vaccine efficacy in the elderly remains debated, and the need for a third booster dose is becoming increasingly evident. Finally, efforts to care for elderly patients who have survived after acute COVID-19 should be implemented, considering the high rates of long COVID sequelae and the risk of longitudinal functional and cognitive decline. IMPLICATIONS We highlight peculiar aspects of COVID-19 in elderly patients and factors contributing to high risk of poor outcome in this category. We also illuminated gaps in current evidence, suggesting future research directions and underlining the need for further studies on the optimal management of elderly patients with COVID-19.
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Affiliation(s)
- Virginie Prendki
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
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Péterfi A, Mészáros Á, Szarvas Z, Pénzes M, Fekete M, Fehér Á, Lehoczki A, Csípő T, Fazekas-Pongor V. Comorbidities and increased mortality of COVID-19 among the elderly: A systematic review. Physiol Int 2022; 109:163-176. [PMID: 35575986 DOI: 10.1556/2060.2022.00206] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 02/18/2024]
Abstract
Purpose The purpose of current review is to conduct a systematic overview of articles published between 2019 and 2021 on the relationship of comorbidities and mortality due to Coronavirus Disease 2019 (COVID-19) among the elderly population. Methods We conducted a systematic search on PubMed for articles published between 2019 and 2021 to identify any cohort and case-control studies that investigated the relationship of comorbidities and COVID-19 mortality among the elderly, defined as 60 years of age and above. Databases were searched independently by two authors. Disagreements were resolved by the inclusion of a third investigator. Reviews, systematic reviews, and meta-analyses were excluded from our systematic review. Results A total of 15 studies were selected for our systematic review. Of the included studies, 3 were case-control, 3 were prospective cohort studies and 9 were retrospective cohort studies. As for size, 10 studies were conducted on populations of <1000 participants, 3 ranging from 1001 to 10,000, and 2 on populations of >10,000 individuals. The included studies found that the presence of certain conditions, such as cardiovascular, respiratory, renal diseases, malignancies, diseases of the nervous system and diabetes are associated to increased mortality in populations that consisted of elderly patients. Conclusion Results of our systematic review suggest that comorbidities contribute to increased COVID-19 mortality among the elderly. The detrimental effect of comorbidities and advanced age on the immune response could lead to a more frequent occurrence of symptomatic and severe infections with COVID-19.
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Affiliation(s)
- Anna Péterfi
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágota Mészáros
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Szarvas
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Melinda Pénzes
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mónika Fekete
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Fehér
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Lehoczki
- 2 National Institute for Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
| | - Tamás Csípő
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- 1 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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28
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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Delirium as a Presenting Symptom of COVID-19. Cogn Behav Neurol 2022; 35:123-129. [PMID: 35486533 PMCID: PMC9148631 DOI: 10.1097/wnn.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
Delirium is a common neurologic manifestation of coronavirus disease 2019 (COVID–19) in older adults who present to the emergency department (ED).
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Dias Custódio AC, Ribas FV, Toledo LV, de Carvalho CJ, Lima LM, de Freitas BAC. Factors associated with the lethality of patients hospitalized with severe acute respiratory syndrome due to COVID-19 in Brazil. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000200. [PMID: 36962158 PMCID: PMC10021557 DOI: 10.1371/journal.pgph.0000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
Due to the high rates of transmission and deaths due to COVID-19, understanding the factors associated with its occurrence, as well as monitoring and implementing control measures should be priority actions in health surveillance, highlighting the use of epidemiological surveillance information systems as an important ally. Thus, the objectives of this study were to calculate the mortality rate of hospitalized patients with severe acute respiratory syndrome due to COVID-19 and to identify factors associated with death, in the period corresponding to epidemiological weeks 01 to 53 of the year 2020. This was a longitudinal study, using the national influenza epidemiological surveillance information system database, routinely collected by healthcare services. The sociodemographic and clinical characteristics of 563,051 hospitalized patients with severe acute respiratory syndrome due to COVID-19 in the five regions of Brazil were analyzed. Cox regression was performed to assess factors associated with patient death during hospitalization. The national lethality rate was 35.7%, and the highest rates of lethality occurred in the Northeast (44.3%) and North (41.2%) regions. During the hospital stay, death was associated with older age (Hazard Ratio-HR = 1.026; p<0.001); male sex (HR = 1.052; p<0.001); living in the North (HR = 1.429; p<0.001), Northeast (HR = 1.271; p<0.001) or Southeast regions of Brazil (HR = 1.040; p<0.001), presenting any risk factor (HR = 1.129; p< 0.001), the use of invasive (HR = 2.865; p<0.001) or noninvasive (HR = 1.401; p<0.001) mechanical ventilation devices. A high case lethality rate was evidenced in patients with severe acute respiratory syndrome due to COVID-19, however, deaths were not evenly distributed across the country's regions, being heavily concentrated in the Northeast and North regions. Older male patients living in the North, Northeast, or Southeast regions of Brazil, who presented any risk factor and were submitted to the use of invasive or noninvasive mechanical ventilation devices, presented a higher risk of evolving to death.
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Affiliation(s)
| | - Fábio Vieira Ribas
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Luana Vieira Toledo
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | | | - Luciana Moreira Lima
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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Sortilin/Omentin-1 ratio in Peripheral Artery Disease: a cross-sectional study on 295 unselected elderly patients. Mech Ageing Dev 2022; 205:111677. [DOI: 10.1016/j.mad.2022.111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
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Akman C, Bardakçı O, Daş M, Akdur G, Akdur O. The Effectiveness of National Early Warning Score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and Elixhauser Comorbidity Index Scores in Predicting Mortality Due to COVID-19 in Elderly Patients. Cureus 2022; 14:e23012. [PMID: 35464509 PMCID: PMC9001189 DOI: 10.7759/cureus.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: As the mortality rate in coronavirus disease 2019 (COVID-19) patients older than 65 years is considerable, evaluation of in-hospital mortality is crucial. This study aimed to evaluate in-hospital mortality in COVID-19 patients older than 65 years using the National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (q-SOFA), Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Methods: This retrospective study included data from 480 patients with confirmed COVID-19 and age over 65 years who were evaluated in a university emergency department in Turkey. Data from eligible but deceased COVID-19 patients was also included. NEWS, q-SOFA, CCI, and ECI scores were retrospectively calculated. All clinical data was accessed from the information management system of the hospital, retrieved, and analyzed. Results: In-hospital mortality was seen in 169 patients (169/480). Low oxygen saturation, high C-reactive protein (CRP) and urea levels, and high q-SOFA and ECI scores helped us identify mortality in high-risk patients. A statistically significant difference was found in mortality estimation between q-SOFA and ECI (p <0.001), respectively. Conclusion: Q-SOFA and ECI can be used both easily and practically in the early diagnosis of in-hospital mortality in COVID-19 positive patients over 65 years of age admitted to the emergency department. Low oxygen saturation, high CRP and urea levels, and high q-SOFA and ECI scores are helpful in identifying high-risk patients.
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Henkens MTHM, Raafs AG, Verdonschot JAJ, Linschoten M, van Smeden M, Wang P, van der Hooft BHM, Tieleman R, Janssen MLF, Ter Bekke RMA, Hazebroek MR, van der Horst ICC, Asselbergs FW, Magdelijns FJH, Heymans SRB. Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study. BMC Geriatr 2022; 22:184. [PMID: 35247983 PMCID: PMC8897728 DOI: 10.1186/s12877-021-02673-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown. METHODS In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis. RESULTS In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p< 0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome. CONCLUSIONS Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities. TRIAL REGISTRATION CAPACITY-COVID ( NCT04325412 ).
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Affiliation(s)
- M T H M Henkens
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.
| | - A G Raafs
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - J A J Verdonschot
- Department of Clinical Genetics, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M van Smeden
- UMCU-Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - P Wang
- Department of Clinical Genetics, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B H M van der Hooft
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Tieleman
- Department of Cardiology, Martini Hospital, Groningen, The Netherlands
| | - M L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R M A Ter Bekke
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - M R Hazebroek
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - I C C van der Horst
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - F J H Magdelijns
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S R B Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Netherlands Heart Institute (NLHI), Utrecht, The Netherlands
- Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
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Salini S, Russo A, De Matteis G, Piccioni A, Della Polla D, Carbone L, Barillaro C, Landi F, Franceschi F, Covino M. Frailty in Elderly Patients with Covid-19: A Narrative Review. Gerontol Geriatr Med 2022; 8:23337214221079956. [PMID: 35274027 PMCID: PMC8902186 DOI: 10.1177/23337214221079956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The SARS CoV-2 pandemic still generates a very high number of affected patients and a
significant mortality rate. It is essential to establish objective criteria to stratify
COVID-19 death risk. Frailty has been identified as a potential determinant of increased
vulnerability in older adults affected by COVID-19, because it may suggest alterations
of physical performance and functional autonomy. Methods We have conducted a narrative review of the literature on the evidences regarding
COVID-19 and the frailty condition. Thirteen observational studies were included. Conclusion Data emerging from the studies indicate that older COVID-19 patients with a frailty
condition have an increased risk of mortality compared with non-frail patients, and this
association is independent of other clinical and demographic factors. A frailty
evaluation is required to help clinicians to better stratify the overall risk of death
for older patients with COVID-19.
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Affiliation(s)
- Sara Salini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Russo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Davide Della Polla
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luigi Carbone
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Christian Barillaro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Landi
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seroconversion and occupational exposure of employees at a Swiss university hospital: A large longitudinal cohort study. Infect Control Hosp Epidemiol 2022; 43:326-333. [PMID: 33736734 PMCID: PMC8082127 DOI: 10.1017/ice.2021.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The dynamics of coronavirus disease 2019 (COVID-19) seroconversion of hospital employees are understudied. We measured the proportion of seroconverted employees and evaluated risk factors for seroconversion during the first pandemic wave. METHODS In this prospective cohort study, we recruited Geneva University Hospitals employees and sampled them 3 times, every 3 weeks from March 30 to June 12, 2020. We measured the proportion of seroconverted employees and determined prevalence ratios of risk factors for seroconversion using multivariate mixed-effects Poisson regression models. RESULTS Overall, 3,421 participants (29% of all employees) were included, with 92% follow-up. The proportion of seroconverted employees increased from 4.4% (95% confidence interval [CI], 3.7%-5.1%) at baseline to 8.5% [(95% CI, 7.6%-9.5%) at the last visit. The proportions of seroconverted employees working in COVID-19 geriatrics and rehabilitation (G&R) wards (32.3%) and non-COVID-19 G&R wards (12.3%) were higher compared to office workers (4.9%) at the last visit. Only nursing assistants had a significantly higher risk of seroconversion compared to office workers (11.7% vs 4.9%; P = .006). Significant risk factors for seroconversion included the use of public transportation (adjusted prevalence ratio, 1.59; 95% CI, 1.25-2.03), known community exposure to severe acute respiratory coronavirus virus 2 (2.80; 95% CI, 2.22-3.54), working in a ward with a nosocomial COVID outbreak (2.93; 95% CI, 2.27-3.79), and working in a COVID-19 G&R ward (3.47; 95% CI, 2.45-4.91) or a non-COVID-19 G&R ward (1.96; 95% CI, 1.46-2.63). We observed an association between reported use of respirators and lower risk of seroconversion (0.73; 95% CI, 0.55-0.96). CONCLUSION Additional preventive measures should be implemented to protect employees in G&R wards. Randomized trials on the protective effect of respirators are urgently needed.
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Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis. Ann Intensive Care 2022; 12:17. [PMID: 35184215 PMCID: PMC8858439 DOI: 10.1186/s13613-021-00977-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The concept of frailty provides an age-independent, easy-to-use tool for risk stratification. We aimed to summarize the evidence on the efficacy of frailty tools in risk assessment in COVID-19 patients. METHODS The protocol was registered (CRD42021241544). Studies reporting on frailty in COVID-19 patients were eligible. The main outcomes were mortality, length of hospital stay (LOH) and intensive care unit (ICU) admission in frail and non-frail COVID-19 patients. Frailty was also compared in survivors and non-survivors. Five databases were searched up to 24th September 2021. The QUIPS tool was used for the risk of bias assessment. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI) using a random effect model. Heterogeneity was assessed using the I2 and χ2 tests. RESULTS From 3640 records identified, 54 were included in the qualitative and 42 in the quantitative synthesis. Clinical Frailty Scale (CFS) was used in 46 studies, the Hospital Frailty Risk Score (HFRS) by 4, the Multidimensional Prognostic Index (MPI) by 3 and three studies used other scores. We found that patients with frailty (CFS 4-9 or HFRS ≥ 5) have a higher risk of mortality (CFS: OR: 3.12; CI 2.56-3.81; HFRS OR: 1.98; CI 1.89-2.07). Patients with frailty (CFS 4-9) were less likely to be admitted to ICU (OR 0.28, CI 0.12-0.64). Quantitative synthesis for LOH was not feasible. Most studies carried a high risk of bias. CONCLUSIONS As determined by CFS, frailty is strongly associated with mortality; hence, frailty-based patient management should be included in international COVID-19 treatment guidelines. Future studies investigating the role of frailty assessment on deciding ICU admission are strongly warranted.
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Kim J, Blaum C, Ferris R, Arcila-Mesa M, Do H, Pulgarin C, Dolle J, Scherer J, Kalyanaraman Marcello R, Zhong J. Factors associated with hospital admission and severe outcomes for older patients with COVID-19. J Am Geriatr Soc 2022; 70:1906-1917. [PMID: 35179781 PMCID: PMC9115084 DOI: 10.1111/jgs.17718] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
Background Morbidity and death due to coronavirus disease 2019 (COVID‐19) experienced by older adults in nursing homes have been well described, but COVID‐19's impact on community‐living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID‐19 risks and outcomes. Methods To investigate the relationship of advanced age (65+), on risk factors associated with COVID‐19 outcomes in community‐living elders, we identified an electronic health records cohort of older patients aged 65+ with laboratory‐confirmed COVID‐19 with and without an ambulatory care visit in the past 24 months (n = 47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID‐19 hospitalization; severe outcomes/Intensive care unit (ICU), intubation, dialysis, stroke, in‐hospital death), and in‐hospital death. The exposures include demographic characteristics, and those with ambulatory records, comorbidities, frailty, and laboratory results. Results The 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non‐Hispanic white, 23.3% non‐Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race–ethnicity, comorbidities, and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID‐19 hospitalization and severe outcomes, with strongest effect in the oldest group. Conclusions In this cohort of community‐dwelling older adults, we provided evidence of age‐specific risk factors for COVID‐19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID‐19 outcomes in community‐living older adults, and the role of engagement in ambulatory care in mitigating severe disease.
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Affiliation(s)
- Jiyu Kim
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine
| | - Caroline Blaum
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine.,National Center for Quality Assurance
| | - Rosie Ferris
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine
| | - Mauricio Arcila-Mesa
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine
| | - Hyungrok Do
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine
| | - Claudia Pulgarin
- Department of Population Health, NYU Grossman School of Medicine
| | - Johanna Dolle
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals
| | - Jennifer Scherer
- Division of Palliative Care and Division of Nephrology, NYU Grossman School of Medicine
| | | | - Judy Zhong
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine
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Zou Y, Han M, Wang J, Zhao J, Gan H, Yang Y. Predictive value of frailty in the mortality of hospitalized patients with COVID-19: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:166. [PMID: 35280387 PMCID: PMC8908186 DOI: 10.21037/atm-22-274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Abstract
Background The present study aimed to analyze the impact of frailty on mortality risk among hospitalized patients with coronavirus disease 2019 (COVID-19). Methods Literature searches were conducted using the MEDLINE, Embase, and Cochrane databases for articles reporting the association between frailty and mortality in hospitalized patients with COVID-19. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). A random-effects meta-analysis was performed to calculate the pooled effects. Results A total of 21 studies with 26,652 hospitalized patients were included. Sixteen studies used the Clinical Frailty Score (CFS), and five used other frailty assessment tools. The pooled estimates of frailty in hospitalized patients with COVID-19 were 51.4% [95% confidence interval (CI): 39.9–62.9%]. In the CFS group, frail patients experienced a higher rate of short-term mortality than non-frail patients [odds ratio (OR) =3.0; 95% CI: 2.3–3.9; I2=72.7%; P<0.001]. In the other tools group, frail patients had a significantly increased short-term mortality risk compared with non-frail patients (OR =2.4; 95% CI: 1.4–4.1; P=0.001). Overall, a higher short-term mortality risk was observed for frail patients than non-frail patients (OR =2.8; 95% CI: 2.3–3.5; P<0.001). In older adults, frail patients had a higher rate of short-term mortality than non-frail patients (OR =2.3; 95% CI: 1.8–2.9; P<0.001). Conclusions Compared to non-frail hospitalized patients with COVID-19, frail patients suffered a higher risk of all-cause mortality, and this result was also found in the older adult group.
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Affiliation(s)
- Yupei Zou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Maonan Han
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huatian Gan
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Premorbid aspirin use is not associated with lower mortality in older inpatients with SARS-CoV-2 pneumonia. GeroScience 2022; 44:573-583. [PMID: 34993763 PMCID: PMC8736303 DOI: 10.1007/s11357-021-00499-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/13/2021] [Indexed: 12/25/2022] Open
Abstract
Platelet aggregation has been associated with COVID-19 pathogenesis. In older patients hospitalized for SARS-CoV-2 pneumonia, we aimed to investigate the association between aspirin use before admission and the risk of in-hospital all-cause mortality. We performed a retrospective international cohort study in five COVID-19 geriatric units in France and Switzerland. Among 1,357 consecutive hospitalized patients aged 75 or older and testing positive for SARS-CoV-2, we included 1,072 with radiologically confirmed pneumonia. To adjust for confounders, a propensity score for treatment was created, and stabilized inverse probability of treatment weighting (SIPTW) was applied. To assess the association between aspirin use and in-hospital 30-day mortality, SIPTW-adjusted Kaplan–Meier and Cox proportional hazards regression analyses were performed. Of the 1047 patients with SARS-CoV-2 pneumonia and median age 86 years, 301 (28.7%) were taking aspirin treatment before admission. One hundred forty-seven (34.3%) patients who had taken aspirin died in hospital within 1 month vs 118 patients (30.7%) without aspirin. After SIPTW, aspirin treatment was not significantly associated with lower mortality (adjusted hazard ratio: 1.10 [0.81–1.49], P = .52). Moreover, patients on aspirin had a longer hospital stay and were more frequently transferred to the intensive care unit. In a large multicenter cohort of older inpatients with SARS-CoV-2 pneumonia, aspirin use before admission did not appear to be associated with an improved prognosis.
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Abbas M, Cori A, Cordey S, Laubscher F, Robalo Nunes T, Myall A, Salamun J, Huber P, Zekry D, Prendki V, Iten A, Vieux L, Sauvan V, Graf CE, Harbarth S. Reconstruction of transmission chains of SARS-CoV-2 amidst multiple outbreaks in a geriatric acute-care hospital: a combined retrospective epidemiological and genomic study. eLife 2022; 11:76854. [PMID: 35850933 PMCID: PMC9328768 DOI: 10.7554/elife.76854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is ongoing uncertainty regarding transmission chains and the respective roles of healthcare workers (HCWs) and elderly patients in nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in geriatric settings. Methods We performed a retrospective cohort study including patients with nosocomial coronavirus disease 2019 (COVID-19) in four outbreak-affected wards, and all SARS-CoV-2 RT-PCR positive HCWs from a Swiss university-affiliated geriatric acute-care hospital that admitted both Covid-19 and non-Covid-19 patients during the first pandemic wave in Spring 2020. We combined epidemiological and genetic sequencing data using a Bayesian modelling framework, and reconstructed transmission dynamics of SARS-CoV-2 involving patients and HCWs, to determine who infected whom. We evaluated general transmission patterns according to case type (HCWs working in dedicated Covid-19 cohorting wards: HCWcovid; HCWs working in non-Covid-19 wards where outbreaks occurred: HCWoutbreak; patients with nosocomial Covid-19: patientnoso) by deriving the proportion of infections attributed to each case type across all posterior trees and comparing them to random expectations. Results During the study period (1 March to 7 May 2020), we included 180 SARS-CoV-2 positive cases: 127 HCWs (91 HCWcovid, 36 HCWoutbreak) and 53 patients. The attack rates ranged from 10% to 19% for patients, and 21% for HCWs. We estimated that 16 importation events occurred with high confidence (4 patients, 12 HCWs) that jointly led to up to 41 secondary cases; in six additional cases (5 HCWs, 1 patient), importation was possible with a posterior probability between 10% and 50%. Most patient-to-patient transmission events involved patients having shared a ward (95.2%, 95% credible interval [CrI] 84.2%-100%), in contrast to those having shared a room (19.7%, 95% CrI 6.7%-33.3%). Transmission events tended to cluster by case type: patientnoso were almost twice as likely to be infected by other patientnoso than expected (observed:expected ratio 2.16, 95% CrI 1.17-4.20, p=0.006); similarly, HCWoutbreak were more than twice as likely to be infected by other HCWoutbreak than expected (2.72, 95% CrI 0.87-9.00, p=0.06). The proportion of infectors being HCWcovid was as expected as random. We found a trend towards a greater proportion of high transmitters (≥2 secondary cases) among HCWoutbreak than patientnoso in the late phases (28.6% vs. 11.8%) of the outbreak, although this was not statistically significant. Conclusions Most importation events were linked to HCW. Unexpectedly, transmission between HCWcovid was more limited than transmission between patients and HCWoutbreak. This finding highlights gaps in infection control and suggests the possible areas of improvements to limit the extent of nosocomial transmission. Funding This study was supported by a grant from the Swiss National Science Foundation under the NRP78 funding scheme (Grant no. 4078P0_198363).
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme & WHO Collaborating Centre on Patient Safety, Geneva University HospitalsGenevaSwitzerland,MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom,Faculty of Medicine, University of GenevaGenevaSwitzerland
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis, Imperial College LondonLondonUnited Kingdom,Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Samuel Cordey
- Faculty of Medicine, University of GenevaGenevaSwitzerland,Laboratory of Virology, Department of Diagnostics, Geneva University HospitalsGenevaSwitzerland
| | - Florian Laubscher
- Laboratory of Virology, Department of Diagnostics, Geneva University HospitalsGenevaSwitzerland
| | - Tomás Robalo Nunes
- Infection Control Programme & WHO Collaborating Centre on Patient Safety, Geneva University HospitalsGenevaSwitzerland,Serviço de Infecciologia, Hospital Garcia de Orta, EPEAlmadaPortugal
| | - Ashleigh Myall
- Department of Infectious Diseases, Imperial College LondonLondonUnited Kingdom,Department of Mathematics, Imperial College LondonLondonUnited Kingdom
| | - Julien Salamun
- Department of Primary Care, Geneva University HospitalsGenevaSwitzerland
| | - Philippe Huber
- Department of Rehabilitation and Geriatrics, Geneva University HospitalsGenevaSwitzerland
| | - Dina Zekry
- Department of Rehabilitation and Geriatrics, Geneva University HospitalsGenevaSwitzerland
| | - Virginie Prendki
- Department of Rehabilitation and Geriatrics, Geneva University HospitalsGenevaSwitzerland,Division of Infectious Diseases, Geneva University HospitalsGenevaSwitzerland
| | - Anne Iten
- Infection Control Programme & WHO Collaborating Centre on Patient Safety, Geneva University HospitalsGenevaSwitzerland
| | - Laure Vieux
- Occupational Health Service, Geneva University HospitalsGenevaSwitzerland
| | - Valérie Sauvan
- Infection Control Programme & WHO Collaborating Centre on Patient Safety, Geneva University HospitalsGenevaSwitzerland
| | - Christophe E Graf
- Department of Rehabilitation and Geriatrics, Geneva University HospitalsGenevaSwitzerland
| | - Stephan Harbarth
- Infection Control Programme & WHO Collaborating Centre on Patient Safety, Geneva University HospitalsGenevaSwitzerland,Faculty of Medicine, University of GenevaGenevaSwitzerland,Division of Infectious Diseases, Geneva University HospitalsGenevaSwitzerland
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Damayanthi HDWT, Prabani KIP, Weerasekara I. Factors Associated for Mortality of Older People With COVID 19: A Systematic Review and Meta-analysis. Gerontol Geriatr Med 2021; 7:23337214211057392. [PMID: 34888405 PMCID: PMC8649451 DOI: 10.1177/23337214211057392] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/28/2021] [Indexed: 01/12/2023] Open
Abstract
Background Whilst people of all ages are affected in some way by COVID-19 virus, older people are at a high mortality risk. This study aimed to systematically review the numerous factors associated with mortality among COVID-19 infected older people. Method PubMed and Science Direct were searched from inception to the April 15, 2021. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and Joanna Briggs Institute critical appraisal tool to assess the methodological quality of the included studies. Results Of the 4957 studies identified, 20 were included in the qualitative analysis, while 10 were included in the quantitative analysis. Male sex (OR = 2.22, 95% CI = 1.23-3.99), age (over 75 years old) (OR = 3.36, 95% CI = 2.30-4.90), Dementia (OR = 3.69, 95% CI = 1.99-6.83) and Dyspnoea (OR = 3.16, 95% CI = 2.61-3.82), were found to be significantly associated with mortality. There is no significant association between Diabetes, or Hypertension. Conclusion Older age, male gender, dyspnoea and dementia were associated with a greater risk of death of older people from COVID-19 infection. These findings may help health care professionals to identify high-risk groups, facilitate appropriate remedial measures, and control mortality among older people.
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Affiliation(s)
- H D W T Damayanthi
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - K I P Prabani
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ishanka Weerasekara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,Adjunct Associate Lecturer, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NTL, Australia
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Alharbi AA, Alqassim AY, Muaddi MA, Alghamdi SS. Regional Differences in COVID-19 Mortality Rates in the Kingdom of Saudi Arabia: A Simulation of the New Model of Care. Cureus 2021; 13:e20797. [PMID: 34987945 PMCID: PMC8716006 DOI: 10.7759/cureus.20797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to assess regional COVID-19 mortality rates and compare the five proposed business units (BUs). Methods A cross-sectional study was conducted in the Ministry of Health (MOH) hospitals in the Kingdom of Saudi Arabia (KSA). We included 1743 adults (≥ 18 years of age) with COVID-19 admitted to any of 30 MOH hospitals. Results The inpatients had confirmed mild to severe COVID-19 between March and mid-July 2020. The central BU (Riyadh) was used as the reference. MOH electronic health record data were reviewed and utilized, including variables reflecting hospital course (mortality and discharge status). The primary outcome was COVID-19-related inpatient death. Covariates included patient demographics, pre-existing chronic diseases, and COVID-19-related complications. The data were analysed using univariate and multivariate logistic regression. KSA inpatient mortality was 30%. Univariate and multivariate logistic regression analysis suggested that COVID-19-related mortality was significantly higher in the northern and western BUs and significantly lower in the southern and eastern BUs than in the central BU. On controlling for other variables, adjusted odds ratios (AORs) for essential COVID-19 mortality predictors during admission, using the central BU as a reference, were as 9.90 [95% CI, 4.53-21.61] and 1.55 [95% CI, 1.04-2.13] times higher in the northern and western BUs, respectively, and 0.60 [95% CI, 0.36-0.99] and 0.23 [95% CI, 0.14-0.038] times lower in the southern and eastern BUs, respectively. Conclusion The five BUs differed in COVID-19 mortality rates after adjusting for patient and disease characteristics, with the differences consistent with those in the regions comprising the BUs. These outcome differences apparently relate to differences in healthcare resources and quality.
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Affiliation(s)
- Abdullah A Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Mohammed A Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Saleh S Alghamdi
- Clinical Audit General Directorate, Ministry of Health, Riyadh, SAU
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Scheffler M, Genton L, Graf CE, Remuinan J, Gold G, Zekry D, Serratrice C, Herrmann FR, Mendes A. Prognostic Role of Subcutaneous and Visceral Adiposity in Hospitalized Octogenarians with COVID-19. J Clin Med 2021; 10:jcm10235500. [PMID: 34884199 PMCID: PMC8658645 DOI: 10.3390/jcm10235500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated the prognostic significance of visceral and subcutaneous adiposity in octogenarians with COVID-19. METHODS This paper presents a monocentric retrospective study that was conducted in acute geriatric wards with 64 hospitalized patients aged 80+ who had a diagnosis of COVID-19 and who underwent a chest CT scan. A quantification of the subcutaneous, visceral, and total fat areas was performed after segmentations on the first abdominal slice caudal to the deepest pleural recess on a soft-tissue window setting. Logistic regression models were applied to investigate the association with in-hospital mortality and the extent of COVID-19 pneumonia. RESULTS The patients had a mean age of 86.4 ± 6.0 years, and 46.9% were male, with a mean BMI of 24.1 ± 4.4Kg/m2 and mortality rate of 32.8%. A higher subcutaneous fat area had a protective effect against mortality (OR 0.416; 0.183-0.944 95% CI; p = 0.036), which remained significant after adjustments for age, sex, and BMI (OR 0.231; 0.071-0.751 95% CI; p = 0.015). Inversely, higher abdominal circumference, total fat area, subcutaneous fat area, and visceral fat were associated with worse COVID-19 pneumonia, with the latter presenting the strongest association after adjustments for age, sex, and BMI (OR 2.862; 1.523-5.379 95% CI; p = 0.001). CONCLUSION Subcutaneous and visceral fat areas measured on chest CT scans were associated with prognosis in octogenarians with COVID-19.
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Affiliation(s)
- Max Scheffler
- Division of Radiology, Diagnostic Department, University Hospitals of Geneva, 1205 Geneva, Switzerland; (M.S.); (J.R.)
| | - Laurence Genton
- Unit of Clinical Nutrition, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Christophe E. Graf
- Division of Internal Medicine and Rehabilitation, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Jorge Remuinan
- Division of Radiology, Diagnostic Department, University Hospitals of Geneva, 1205 Geneva, Switzerland; (M.S.); (J.R.)
| | - Gabriel Gold
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; (G.G.); (F.R.H.)
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; (D.Z.); (C.S.)
| | - Christine Serratrice
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; (D.Z.); (C.S.)
| | - François R. Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; (G.G.); (F.R.H.)
| | - Aline Mendes
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; (G.G.); (F.R.H.)
- Correspondence: ; Tel.: +41-079-553-83-65
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Abbas M, Robalo Nunes T, Cori A, Cordey S, Laubscher F, Baggio S, Jombart T, Iten A, Vieux L, Teixeira D, Perez M, Pittet D, Frangos E, Graf CE, Zingg W, Harbarth S. Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction. J Hosp Infect 2021; 117:124-134. [PMID: 34461177 PMCID: PMC8393517 DOI: 10.1016/j.jhin.2021.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nosocomial outbreaks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are frequent despite implementation of conventional infection control measures. An outbreak investigation was undertaken using advanced genomic and statistical techniques to reconstruct likely transmission chains and assess the role of healthcare workers (HCWs) in SARS-CoV-2 transmission. METHODS A nosocomial SARS-CoV-2 outbreak in a university-affiliated rehabilitation clinic was investigated, involving patients and HCWs, with high coverage of pathogen whole-genome sequences (WGS). The time-varying reproduction number from epidemiological data (Rt) was estimated, and maximum likelihood phylogeny was used to assess genetic diversity of the pathogen. Genomic and epidemiological data were combined into a Bayesian framework to model the directionality of transmission, and a case-control study was performed to investigate risk factors for nosocomial SARS-CoV-2 acquisition in patients. FINDINGS The outbreak lasted from 14th March to 12th April 2020, and involved 37 patients (31 with WGS) and 39 employees (31 with WGS), 37 of whom were HCWs. Peak Rt was estimated to be between 2.2 and 3.6. The phylogenetic tree showed very limited genetic diversity, with 60 of 62 (96.7%) isolates forming one large cluster of identical genomes. Despite the resulting uncertainty in reconstructed transmission events, the analyses suggest that HCWs (one of whom was the index case) played an essential role in cross-transmission, with a significantly greater fraction of infections (P<2.2e-16) attributable to HCWs (70.7%) than expected given the number of HCW cases (46.7%). The excess of transmission from HCWs was higher when considering infection of patients [79.0%; 95% confidence interval (CI) 78.5-79.5%] and frail patients (Clinical Frailty Scale score >5; 82.3%; 95% CI 81.8-83.4%). Furthermore, frail patients were found to be at greater risk for nosocomial COVID-19 than other patients (adjusted odds ratio 6.94, 95% CI 2.13-22.57). INTERPRETATION This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, this study shows that despite such uncertainty, significant transmission patterns can be observed.
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Affiliation(s)
- M Abbas
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
| | - T Robalo Nunes
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Serviço de Infecciologia, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - A Cori
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK; The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - S Cordey
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - F Laubscher
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - S Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland; Office of Correction, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
| | - T Jombart
- The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK; Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - A Iten
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - L Vieux
- Occupational Health Service, Geneva University Hospitals, Geneva, Switzerland
| | - D Teixeira
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - M Perez
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - D Pittet
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - E Frangos
- Clinique de Joli-Mont, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - C E Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - W Zingg
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Infection Control Programme, Zurich University Hospital, Zurich, Switzerland
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010671. [PMID: 34682421 PMCID: PMC8535841 DOI: 10.3390/ijerph182010671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022]
Abstract
Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2.
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A new SARS-CoV-2 variant with high lethality poorly detected by RT-PCR on nasopharyngeal samples: an observational study. Clin Microbiol Infect 2021; 28:298.e9-298.e15. [PMID: 34627988 PMCID: PMC8496927 DOI: 10.1016/j.cmi.2021.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
Objectives In early January 2021 an outbreak of nosocomial cases of coronavirus disease 2019 (COVID-19) emerged in Western France; RT-PCR tests were repeatedly negative on nasopharyngeal samples but positive on lower respiratory tract samples. Whole-genome sequencing (WGS) revealed a new variant, currently defining a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage B.1.616. In March, the WHO classified this as a ‘variant under investigation’ (VUI). We analysed the characteristics and outcomes of COVID-19 cases related to this new variant. Methods Clinical, virological, and radiological data were retrospectively collected from medical charts in the two hospitals involved. We enrolled those inpatients with: (a) positive SARS-CoV-2 RT-PCR on a respiratory sample, (b) seroconversion with anti-SARS-CoV-2 IgG/IgM, or (c) suggestive symptoms and typical features of COVID-19 on a chest CT scan. Cases were categorized as B.1.616, a variant of concern (VOC), or unknown. Results From 1st January to 24th March 2021, 114 patients fulfilled the inclusion criteria: B.1.616 (n = 39), VOC (n = 32), and unknown (n = 43). B.1.616-related cases were older than VOC-related cases (81 years, interquartile range (IQR) 73–88 versus 73 years, IQR 67–82, p < 0.05) and their first RT-PCR tests were rarely positive (6/39, 15% versus 31/32, 97%, p < 0.05). The B.1.616 variant was independently associated with severe disease (multivariable Cox model HR 4.0, 95%CI 1.5–10.9) and increased lethality (28-day mortality 18/39 (46%) for B.1.616 versus 5/32 (16%) for VOC, p = 0.006). Conclusion We report a nosocomial outbreak of COVID-19 cases related to a new variant, B.1.616, which is poorly detected by RT-PCR on nasopharyngeal samples and is associated with high lethality.
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Zuin M, Rigatelli G, Bilato C, Cervellati C, Zuliani G, Roncon L. Dyslipidaemia and mortality in COVID-19 patients: a meta-analysis. QJM 2021; 114:390-397. [PMID: 33822215 PMCID: PMC8083520 DOI: 10.1093/qjmed/hcab071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/29/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. AIM To assess the prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. DESIGN Systematic review and meta-analysis. METHODS Preferred reporting items for systematic reviews and meta-analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 31 January 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random-effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random-effect models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. RESULTS Of about 18 studies, enrolling 74 132 COVID-19 patients (mean age 70.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, P < 0.0001), with high heterogeneity (I2 = 98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-term death (OR: 1.69, 95% CI: 1.19-2.41, P = 0.003), with high heterogeneity (I2 = 88.7%). Due to publication bias, according to the Trim-and-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, P < 0.0001 (one studies trimmed). CONCLUSION Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-term mortality risk.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Carlo Cervellati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
- Corresponding author: Prof. Loris Roncon MD, Department of Cardiology, Rovigo General Hospital, Viale tre Martiri, Rovigo 45100, Italy. Tel.+390425393286; Fax: +390425393597,
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Liu L, Ni SY, Yan W, Lu QD, Zhao YM, Xu YY, Mei H, Shi L, Yuan K, Han Y, Deng JH, Sun YK, Meng SQ, Jiang ZD, Zeng N, Que JY, Zheng YB, Yang BN, Gong YM, Ravindran AV, Kosten T, Wing YK, Tang XD, Yuan JL, Wu P, Shi J, Bao YP, Lu L. Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine 2021; 40:101111. [PMID: 34514362 PMCID: PMC8424080 DOI: 10.1016/j.eclinm.2021.101111] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and has been found to be closely associated with mental and neurological disorders. We aimed to comprehensively quantify the association between mental and neurological disorders, both pre-existing and subsequent, and the risk of susceptibility, severity and mortality of COVID-19. METHODS In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, PsycINFO, and Cochrane library databases for studies published from the inception up to January 16, 2021 and updated at July 7, 2021. Observational studies including cohort and case-control, cross-sectional studies and case series that reported risk estimates of the association between mental or neurological disorders and COVID-19 susceptibility, illness severity and mortality were included. Two researchers independently extracted data and conducted the quality assessment. Based on I2 heterogeneity, we used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI). Subgroup analyses and meta-regression analysis were also performed. This study was registered on PROSPERO (registration number: CRD 42021230832). FINDING A total of 149 studies (227,351,954 participants, 89,235,737 COVID-19 patients) were included in this analysis, in which 27 reported morbidity (132,727,798), 56 reported illness severity (83,097,968) and 115 reported mortality (88,878,662). Overall, mental and neurological disorders were associated with a significant high risk of infection (pre-existing mental: OR 1·67, 95% CI 1·12-2·49; and pre-existing neurological: 2·05, 1·58-2·67), illness severity (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; neurological: pre-existing, 1·43, 1·09-1·88; sequelae, 2·17, 1·45-3·24), and mortality (mental: pre-existing, 1·47, 1·26-1·72; neurological: pre-existing, 2·08, 1·61-2·69; sequelae, 2·03, 1·66-2·49) from COVID-19. Subgroup analysis revealed that association with illness severity was stronger among younger COVID-19 patients, and those with subsequent mental disorders, living in low- and middle-income regions. Younger patients with mental and neurological disorders were associated with higher mortality than elders. For type-specific mental disorders, susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder (ADHD); illness severity was associated with both pre-existing and subsequent mood disorders as well as sleep disturbance; and mortality was associated with pre-existing schizophrenia. For neurological disorders, susceptibility was associated with pre-existing dementia; both severity and mortality were associated with subsequent delirium and altered mental status; besides, mortality was associated with pre-existing and subsequent dementia and multiple specific neurological diseases. Heterogeneities were substantial across studies in most analysis. INTERPRETATION The findings show an important role of mental and neurological disorders in the context of COVID-19 and provide clues and directions for identifying and protecting vulnerable populations in the pandemic. Early detection and intervention for neurological and mental disorders are urgently needed to control morbidity and mortality induced by the COVID-19 pandemic. However, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. More studies are needed to explore long-term mental and neurological sequela, as well as the underlying brain mechanisms for the sake of elucidating the causal pathways for these associations. FUNDING This study is supported by grants from the National Key Research and Development Program of China, the National Natural Science Foundation of China, Special Research Fund of PKUHSC for Prevention and Control of COVID-19, and the Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Lin Liu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Shu-Yu Ni
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Qing-Dong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Ying-Ying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Huan Mei
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jia-Hui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yan-Kun Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Zheng-Dong Jiang
- Wuhan Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jian-Yu Que
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Bei-Ni Yang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Yi-Miao Gong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | | | - Thomas Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang-Dong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center and Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Liang Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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Dumitrascu F, Branje KE, Hladkowicz ES, Lalu M, McIsaac DI. Association of frailty with outcomes in individuals with COVID-19: A living review and meta-analysis. J Am Geriatr Soc 2021; 69:2419-2429. [PMID: 34048599 PMCID: PMC8242611 DOI: 10.1111/jgs.17299] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Frailty leaves older adults vulnerable to adverse health outcomes. Frailty assessment is recommended by multiple COVID-19 guidelines to inform care and resource allocation. We aimed to identify, describe, and synthesize studies reporting the association of frailty with outcomes (informed by the Institute for Healthcare Improvement's Triple Aim [health, resource use, and experience]) in individuals with COVID-19. DESIGN Systematic review and meta-analysis. SETTING Studies reporting associations between frailty and outcomes in the setting of COVID-19 diagnosis. PARTICIPANTS Adults with COVID-19. MEASUREMENTS Following review of titles, abstracts and full text, we included 52 studies that contained 118,373 participants with COVID-19. Risk of bias was assessed using the Quality in Prognostic studies tool. Our primary outcome was mortality, secondary outcomes included delirium, intensive care unit admission, need for ventilation and discharge location. Where appropriate, random-effects meta-analysis was used to pool adjusted and unadjusted effect measures by frailty instrument. RESULTS The Clinical Frailty Scale (CFS) was the most used frailty instrument. Mortality was reported in 37 studies. After confounder adjustment, frailty identified using the CFS was significantly associated with mortality in COVID-19 positive patients (odds ratio 1.79, 95% confidence interval [CI] 1.49-2.14; hazard ratio 1.87, 95% CI 1.33-2.61). On an unadjusted basis, frailty identified using the CFS was significantly associated with increased odds of delirium and reduced odds of intensive care unit admission. Results were generally consistent using other frailty instruments. Patient-reported, cost and experience outcomes were rarely reported. CONCLUSION Frailty is associated with a substantial increase in mortality risk in COVID-19 patients, even after adjustment. Delirium risk is also increased. Frailty assessment may help to guide prognosis and individualized care planning, but data relating frailty status to patient-reported outcomes are urgently needed to provide a more comprehensive overview of outcomes relevant to older adults.
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Affiliation(s)
| | - Karina E. Branje
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - Emily S. Hladkowicz
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- School of Rehabilitation TherapyQueen's UniversityKingstonCanada
| | - Manoj Lalu
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
| | - Daniel I. McIsaac
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
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