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Fekete M, Major D, Feher A, Fazekas-Pongor V, Lehoczki A. Geroscience and pathology: a new frontier in understanding age-related diseases. Pathol Oncol Res 2024; 30:1611623. [PMID: 38463143 PMCID: PMC10922957 DOI: 10.3389/pore.2024.1611623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024]
Abstract
Geroscience, a burgeoning discipline at the intersection of aging and disease, aims to unravel the intricate relationship between the aging process and pathogenesis of age-related diseases. This paper explores the pivotal role played by geroscience in reshaping our understanding of pathology, with a particular focus on age-related diseases. These diseases, spanning cardiovascular and cerebrovascular disorders, malignancies, and neurodegenerative conditions, significantly contribute to the morbidity and mortality of older individuals. We delve into the fundamental cellular and molecular mechanisms underpinning aging, including mitochondrial dysfunction and cellular senescence, and elucidate their profound implications for the pathogenesis of various age-related diseases. Emphasis is placed on the importance of assessing key biomarkers of aging and biological age within the realm of pathology. We also scrutinize the interplay between cellular senescence and cancer biology as a central area of focus, underscoring its paramount significance in contemporary pathological research. Moreover, we shed light on the integration of anti-aging interventions that target fundamental aging processes, such as senolytics, mitochondria-targeted treatments, and interventions that influence epigenetic regulation within the domain of pathology research. In conclusion, the integration of geroscience concepts into pathological research heralds a transformative paradigm shift in our understanding of disease pathogenesis and promises breakthroughs in disease prevention and treatment.
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Affiliation(s)
- Monika Fekete
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - David Major
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Agnes Feher
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | | | - Andrea Lehoczki
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
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Georgakopoulou VE, Gkoufa A, Makrodimitri S, Tsakanikas A, Basoulis D, Voutsinas PM, Karamanakos G, Eliadi I, Samara S, Triantafyllou M, Eleftheriadou I, Kampouropoulou O, Papageorgiou CV, Anastasopoulou A, Papalexis P, Trakas I, Trakas N, Spandidos DA, Steiropoulos P, Sipsas NV. Risk factors for the in‑hospital and 1‑year mortality of elderly patients hospitalized due to COVID‑19‑related pneumonia. Exp Ther Med 2024; 27:22. [PMID: 38125348 PMCID: PMC10728907 DOI: 10.3892/etm.2023.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and a high mortality rate, particularly among elderly patients. Since the beginning of the pandemic, an older age has been recognized as a critical risk factor for disease severity, with increasing mortality rates in each decade of life. This phenomenon may be a consequence of a poor previous health status, with a higher prevalence of pre-existing comorbidities and a higher degree of frailty. The majority of studies on the outcomes and risk factors of elderly patients refer to the first waves of the pandemic and the predictors of in-hospital mortality in these patients. The aim of the present study was to provide a detailed description of the clinical characteristics and management of a cohort of elderly patients (≥65 years of age) who were hospitalized with COVID-19-related pneumonia in all phases of the pandemic, presenting their outcomes, and investigating predictors of in-hospital and out-of-hospital mortality over a period of 1 year in this particularly vulnerable population. A total of 1,124 elderly patients (603 males, 53.7%) with a mean age of 78.51±7.42 years and a median Charlson comorbidity index (CCI) of 5 were included in the study. Of these patients, 104 (9.3%) were hospitalized during the period of prevalence of the original strain Wuhan, 385 (34.3%) were hospitalized during the period of prevalence of the Alpha variant, 221 (19.7%) were hospitalized during the period of prevalence of the Delta variant, and 414 (36.8%) were hospitalized during the period of prevalence of the Omicron variant. Overall, the in-hospital mortality rate was 33.4% (375 patients), and the 1-year mortality rate was 44.7% (502 patients). The majority of patients had not been vaccinated or had not completed full vaccination against severe acute respiratory syndrome coronavirus-2 (843 patients, 75%), given the period of infection. Age, immature granulocytes, lactate dehydrogenase (LDH) levels, ferritin levels, chest X-ray score, as well as the absence of full vaccination, cough and fatigue, were statistically significantly and independently associated with in-hospital mortality, while age, LDH levels, ferritin levels, alanine aminotransferase levels, CCI, chest X-ray score, the absence of cough and fatigue, and a history of dementia were statistically significantly and independently associated with 1-year mortality. On the whole, the present study demonstrates that both the in-hospital mortality and 1-year mortality rates of elderly patients hospitalized due to COVID-19-related pneumonia are high.
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Affiliation(s)
- Vasiliki Epameinondas Georgakopoulou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aikaterini Gkoufa
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sotiria Makrodimitri
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aristeidis Tsakanikas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Basoulis
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pantazis M. Voutsinas
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Karamanakos
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Eliadi
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stamatia Samara
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Triantafyllou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioanna Eleftheriadou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Olga Kampouropoulou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Chrysovalantis V. Papageorgiou
- Pulmonology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amalia Anastasopoulou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Ilias Trakas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nikolaos V. Sipsas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Chuansangeam M, Srithan B, Pattharanitima P, Phadungsaksawasdi P. Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand. Medicines (Basel) 2023; 10:59. [PMID: 37999199 PMCID: PMC10672742 DOI: 10.3390/medicines10110059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Abstract
Background: Early detection of elderly patients with COVID-19 who are at high risk of mortality is vital for appropriate clinical decisions. We aimed to evaluate the risk factors associated with all-cause in-hospital mortality among elderly patients with COVID-19. Methods: In this retrospective study, the medical records of elderly patients aged over 60 who were hospitalized with COVID-19 at Thammasat University Hospital from 1 July to 30 September 2021 were reviewed. Multivariate logistic regression was used to identify independent predictors of mortality. The sum of weighted integers was used as a total risk score for each patient. Results: In total, 138 medical records of patients were reviewed. Four identified variables based on the odds ratio (age, respiratory rate, glomerular filtration rate and history of stroke) were assigned a weighted integer and were developed to predict mortality risk in hospitalized elderly patients. The AUROC of the scoring system were 0.9415 (95% confidence interval, 0.9033-0.9716). The optimized scoring system was developed and a risk score over 213 was considered a cut-off point for high mortality risk. Conclusions: A simple predictive risk score provides an initial assessment of mortality risk at the time of admission with a high degree of accuracy among hospitalized elderly patients with COVID-19.
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Affiliation(s)
- Mallika Chuansangeam
- Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani 12120, Thailand
| | - Bunyarat Srithan
- Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani 12120, Thailand
| | - Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani 12120, Thailand
| | - Pawit Phadungsaksawasdi
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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Bianco C, Guidet B, Flaatten H, Dechartres A, Vallet H. Mortality in older patients admitted to an ICU for COVID-19: A systematic review. Acta Anaesthesiol Scand 2023; 67:1140-1147. [PMID: 37323022 DOI: 10.1111/aas.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/06/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID-19. MATERIALS AND METHODS Data sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID-19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist. RESULTS We selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1-month mortality from 33% to 90% and 3-month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1-month and 3-month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56-4.13] and HR: 2.83 [95% CI: 1.96-4.08]). CONCLUSION In this systematic review of older patients admitted to an ICU with COVID-19, we documented high heterogeneity of mortality rates.
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Affiliation(s)
- Céline Bianco
- Department of Geriatrics, Saint Antoine Hospital, APHP, Paris, France
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Réanimation Médicale, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Agnès Dechartres
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
| | - Hélène Vallet
- Sorbonne Université, INSERM, UMRS 1135, Centre d'immunologie et de Maladies Infectieuses (CIMI), Department of Geriatrics, Saint Antoine Hospital, APHP, Paris, France
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Thietart S, Rozes A, Tubach F, Marot S, Marcelin AG, Raux M, Vallet H, Riou B, Boddaert J, Zerah L. In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study. BMC Geriatr 2023; 23:573. [PMID: 37723419 PMCID: PMC10507910 DOI: 10.1186/s12877-023-04236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Mortality is high in older patients hospitalized with COVID-19. Previous studies observed lower mortality during the Omicron wave, yet no data is available on older patients. The objective was to compare in-hospital mortality between the Omicron and previous waves in older patients hospitalized with COVID-19. METHODS This retrospective observational multicenter cohort study used the Greater Paris University Hospitals Group's data warehouse (38 hospitals). Patients aged ≥ 75 years with a confirmed COVID-19 diagnosis and hospitalized from March 2020 to January 2022 were included. The study period was divided into five waves. The fifth wave (January 1st to 31st 2022) was considered as the Omicron wave as it was the predominant variant (≥ 50%), and was compared with waves 1 (March-July 2020), 2 (August-December 2020), 3 (January-June 2021) and 4 (July-December 2021). Primary outcome was in-hospital mortality. Secondary outcome was occurrence of ICU admission or in-hospital death. Multivariate logistic regression was performed, with a sensitivity analysis according to variant type. RESULTS Of the 195,084 patients hospitalized with COVID-19, 19,909 patients aged ≥ 75 years were included (median age 85 [IQR 79-90] years, 53% women). Overall in-hospital mortality was 4,337 (22%), reaching 345 (17%) during wave 5. Waves 1 and 3 were significantly associated with increased in-hospital mortality in comparison with wave 5 (adjusted Odds Ratios aOR 1.42 [95%CI 1.21-1.66] and 1.56 [95%CI 1.33-1.83] respectively). Waves 1 to 3 were associated with an increased risk of occurrence of ICU admission or in-hospital death in comparison with wave 5: aOR 1.29 [95% CI 1.12 to 1.49] for wave 1, aOR 1.25 [95% CI 1.08 to 1.45] for wave 2 and aOR 1.56 [95% CI 1.36 to 1.79] for wave 3. Sensitivity analysis found that Omicron variant was associated with decreased mortality, in comparison with previous variants. CONCLUSIONS Mortality was lower during the 5th Omicron wave in the older population, but remained high, implying that this variant could be considered as "milder" but not "mild". This persistently high mortality during the 5th Omicron wave highlights the importance of including older patients in clinical trials to confirm the benefit/risk balance of COVID-19 treatments in this fragile population.
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Affiliation(s)
- Sara Thietart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié- Salpêtrière, Département de Gériatrie, Paris, France
| | - Antoine Rozes
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, Paris, F75013, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, Paris, F75013, France
| | - Stéphane Marot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Virologie, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158, AP-HP, Hôpital Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
| | - Hélène Vallet
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), AP-HP, Hôpital Saint Antoine, Département de Gériatrie, Paris, France
| | - Bruno Riou
- Sorbonne Université, UMRS INSERM 1166, IHU ICAN, AP-HP, Hôpital Pitié- Salpêtrière, Département des Urgences, Paris, France
| | - Jacques Boddaert
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Gériatrie, Paris, France
| | - Lorène Zerah
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Gériatrie, Paris, France.
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Sarıoğlu E, Sarıaltın SY, Çoban T. Neurological complications and effects of COVID-19: Symptoms and conceivable mechanisms. Brain Hemorrhages 2023; 4:154-173. [PMID: 36789140 PMCID: PMC9911160 DOI: 10.1016/j.hest.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.
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Affiliation(s)
- Elif Sarıoğlu
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Sezen Yılmaz Sarıaltın
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Tülay Çoban
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
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Brière O, Otekpo M, Asfar M, Gautier J, Sacco G, Annweiler C. Initial functional disability as a 1-year prognostic factor in geriatric patients hospitalized with SARS-CoV-2 infection. PLoS One 2023; 18:e0289297. [PMID: 37498909 PMCID: PMC10374042 DOI: 10.1371/journal.pone.0289297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND SARS-CoV2 infection has affected many older people and has required us to adapt our practices to this new pathology. Initial functional capacity is already considered an important prognostic marker in older patients particularly during infections. AIM The objective of this longitudinal study was to determine whether baseline functional disability was associated with mortality risk after 1 year in older patients hospitalized for COVID-19. METHODS All COVID-19 patients admitted to the geriatric acute care unit of Angers University Hospital, France, between March-June 2020 received a group iso-ressource (GIR) assessment upon admission. Disability was defined as a GIR score≤3. All-cause mortality was collected after 1 year of follow-up. Covariables were age, sex, history of malignancies, hypertension, cardiomyopathy, number of acute diseases at baseline, and use of antibiotics or respiratory treatments during COVID-19 acute phase. RESULTS In total, 97 participants (mean±SD 88.0+5.4 years; 49.5% women; 46.4% GIR score≤3) were included. 24 of the 36 patients who did not survive 1 year had a GIR score ≤ 3 (66.7%; P = 0.003). GIR score≤3 was directly associated with 1-year mortality (fully adjusted HR = 2.27 95% CI: 1.07-4.89). Those with GIR≤3 at baseline had shorter survival time than the others (log-rank P = 0.0029). CONCLUSIONS Initial functional disability was associated with poorer survival in hospitalized frail elderly COVID-19 patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT04560608 registered on September 23, 2022.
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Affiliation(s)
- Olivier Brière
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Marie Otekpo
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Marine Asfar
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Jennifer Gautier
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Guillaume Sacco
- University Côte d'Azur, Nice, France
- Department of Geriatric Medecine and Brain Clinic, Nice, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UNIV ANGERS, University of Angers, Angers, France
- Gérontopôle Autonomie Longévité des Pays de la Loire, Nantes, France
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
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Munawar N, Syed R, Costello M, Robinson D, Bergin C, Greene E. Risk factors and outcomes of delirium in hospitalized older adults with COVID-19: A systematic review and meta-analysis. Aging Health Res 2023; 3:100125. [PMID: 36778764 DOI: 10.1016/j.ahr.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Background Older adults with COVID-19 are more likely to present with atypical symptoms, notably delirium. The main objective of this meta-analysis is to identify risk factors for delirium and outcomes of delirium in hospitalized older adults (65 years or above) with COVID-19. Methods Comprehensive literature search of Embase, CINAHIL, Medline and Web of Science was performed for published literature until 31st August 2021. Two independent researchers evaluated study eligibility and assessed study quality using the Newcastle Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) critical appraisal tools for case series. The association of various predisposing factors with delirium in this cohort was reported as odds ratio (OR) and its 95% confidence interval (CI). Results A total of 31 studies from 11 countries were included in this review. Most of the included studies investigated patients from non-ICU settings (n = 24; 77.4%). Frailty (OR 3.52, 95% CI: 1.96-6.31, p<0.0001, I2=71.63%), cognitive impairment including dementia (OR 6.17, 95% CI: 2.92-13.07, p<0.00001, I2=88.63%) and being nursing home residents (OR 1.72, 95% CI: 1.31-2.24, p<0.0001, I2=0) were significantly associated with increased likelihood of developing delirium in older adults with COVID-19. The presence of delirium also significantly increases mortality risk in hospitalized older adults with COVID-19 (OR 2.51, 95% CI: 1.51-4.17, p<0.0001, I2=89.3%). Conclusion Our review identifies key factors associated with increased risk of developing delirium in hospitalized older adults with COVID-19. Identification of patients at risk of delirium and attention to these factors early during admission may improve outcomes for this vulnerable cohort.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Oscanoa TJ, Amado-Tineo J, Ayala-García R, Mamani-Quiroz R, Matta-Pérez J, Ardiles-Melgarejo Á, Marcos-Hernández C, Taype-Huamaní W, Rojas-Guimaray J, Matos-Santiváñez S, Miranda-Chávez L, Deza-Sime A, Apolaya-Segura M, Romero-Ortuno R. Clinical features and mortality predictors of older hospitalized patients with severe COVID-19 in Lima, Perú. JGG 2022. [DOI: 10.36150/2499-6564-n470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Saini A, Oh TH, Ghanem DA, Castro M, Butler M, Sin Fai Lam CC, Posporelis S, Lewis G, David AS, Rogers JP. Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study. Aging Ment Health 2022; 26:2054-2061. [PMID: 34651536 DOI: 10.1080/13607863.2021.1989375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to find the association of inflammation and respiratory failure with delirium in COVID-19 patients. We compare the inflammatory and arterial blood gas markers between patients with COVID-19 delirium and delirium in other medical disorders. METHODS This cross-sectional study used the CHART-DEL, a validated research tool, to screen patients for delirium retrospectively from clinical notes. Inflammatory markers C-reactive protein (CRP) and white cell count (WBC), and the partial pressures of oxygen (PO2) and carbon dioxide (PCO2) were compared between patients with COVID-19 delirium and delirium in other medical disorders. RESULTS In bivariate analysis, CRP (mg/L) was significantly higher in the COVID-19 group, (81.7 ± 80.0 vs. 58.8 ± 87.7, p = 0.04), and WBC (109/L) was significantly lower (7.44 ± 3.42 vs. 9.71 ± 5.45, p = 0.04). The geometric mean of CRP in the COVID-19 group was 140% higher in multiple linear regression (95% CI = 7-439%, p = 0.03) with age and sex as covariates. There were no significant differences in pO2 or pCO2 across groups. CONCLUSION The association between higher CRP and COVID-19 in patients with delirium may suggest an inflammatory basis for delirium in COVID-19. Our findings may assist clinicians in establishing whether delirium is due to COVID-19, which may improve management and outcomes of infected patients.
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Affiliation(s)
- Aman Saini
- Medical School, University College London, London, UK
| | - Tae Hyun Oh
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Megan Castro
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Sotiris Posporelis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Jonathan P Rogers
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
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12
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Komici K, Bencivenga L, Rengo G. Editorial: Post COVID-19 physical performance and functional capacity. Front Med (Lausanne) 2022; 9:920645. [PMID: 35966844 PMCID: PMC9373793 DOI: 10.3389/fmed.2022.920645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
- *Correspondence: Klara Komici
| | - Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
- Leonardo Bencivenga
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Societa Benefit (ICS Maugeri SpA SB), Telese Terme, Italy
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13
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Merz EL, Gholizadeh S. Mental and Physical Health Concerns in the Context of COVID-19: Opportunities and Applications for Behavioral Medicine. Focus (Am Psychiatr Publ) 2022; 20:292-300. [PMID: 37205014 PMCID: PMC10172526 DOI: 10.1176/appi.focus.20220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Numerous physical and mental health concerns have been documented in the context of COVID-19, and it is likely that patients, survivors, frontline health care workers, and other affected individuals will present to psychiatry for treatment. Behavioral medicine, an interdisciplinary field that is defined by a behavioral and biomedical conceptualization of clinical care, offers an opportunity for collaboration with psychiatry and other health care providers to meet the myriad needs resulting from the pandemic. This review summarizes a conceptual framework of behavioral medicine and clinical health psychology, COVID-19-related quality of life concerns that may be applicable to behavioral medicine referrals, clinical assessment directions, and intervention opportunities. The review combines both findings specific to COVID-19 and general behavioral medicine principles with an overall goal of providing a basic introduction to behavioral medicine practice, applications, and opportunities for management of medical and psychological symptoms.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, College of Natural and Behavioral Sciences, California State University, Dominguez Hills, Carson (Merz); TheKey Research Group™, San Diego (Gholizadeh)
| | - Shadi Gholizadeh
- Department of Psychology, College of Natural and Behavioral Sciences, California State University, Dominguez Hills, Carson (Merz); TheKey Research Group™, San Diego (Gholizadeh)
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14
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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] [What about the content of this article? (0)] [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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15
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Lidou-Renault V, Baudouin E, Courtois-Amiot P, Bianco C, Esnault H, Rouet A, Baque M, Tomeo C, Rainone A, Thietart S, Veber R, Ayache C, Pepin M, Lafuente-Lafuente C, Duron E, Cailleaux PE, Haguenauer D, Lemarié N, Paillaud E, Raynaud-Simon A, Thomas C, Boddaert J, Zerah L, Vallet H. Corticosteroid therapy in COVID-19 associated with in-hospital mortality in geriatric patients: a propensity matched cohort study. J Gerontol A Biol Sci Med Sci 2022; 77:1352-1360. [PMID: 35395678 PMCID: PMC9129112 DOI: 10.1093/gerona/glac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not. Methods We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used. Results Of the 1 579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81–91) years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1–4), and 64% of patients were frail (Clinical Frailty Score 5–9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroid use (odds ratio [OR] = 2.61 [95% confidence interval (CI) 1.63–4.20]). Other factors associated with in-hospital mortality were age (OR = 1.04 [1.01–1.07], CCI (OR = 1.18 [1.07–1.29], activities of daily living (OR = 0.85 [0.75–0.95], oxygen saturation < 90% on room air (OR = 2.15 [1.45–3.17], C-reactive protein level (OR = 2.06 [1.69–2.51], and lowest lymphocyte count (OR = 0.49 [0.38–0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium (32.9%), secondary infections (32.7%), and decompensated diabetes (14.4%). Conclusions In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality.
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Affiliation(s)
| | | | - Pauline Courtois-Amiot
- Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine, Paris, France
| | - Celine Bianco
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine, Paris, France
| | - Hélène Esnault
- Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine, Paris, France
| | - Audrey Rouet
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Tenon, Department of Geriatric Medicine, Paris, France
| | - Margaux Baque
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine, Paris, France
- Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses, Paris, France
| | - Charlotte Tomeo
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine, Paris, France
| | - Antonio Rainone
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Charles Foix, Department of Geriatric Medicine, Ivry Sur Seine, France
| | - Sara Thietart
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine, Paris, France
| | - Romain Veber
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine, Paris, France
| | - Clementine Ayache
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Rothschild, Department of Geriatric Medicine, Paris, France
| | - Marion Pepin
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Ambroise Paré, Department of Geriatric Medicine, Boulogne, Billancourt, France
- Université de Versailles Saint-Quentin en Yvelines, Université Paris-Saclay, INSERM, CESP, Clinical Epidemiology, Villejuif, France
| | - Carmelo Lafuente-Lafuente
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Charles Foix, Department of Geriatric Medicine, Ivry Sur Seine, France
| | - Emmanuelle Duron
- Assistance Publique-Hôpitaux de Paris (APHP), University hospital of Paris-Saclay, Department of Geriatric Medicine, Paul Brousse Hospital, Villejuif, France
- Université Paris-Saclay, INSERM 1178, CESP, Équipe MOODS, Le Kremlin-Bicêtre, France
| | - Pierre-Emmanuel Cailleaux
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Department of Geriatric Medicine, Colombes, France
| | - Didier Haguenauer
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Department of Geriatric Medicine, Colombes, France
| | - Nadège Lemarié
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Tenon, Department of Geriatric Medicine, Paris, France
| | - Elena Paillaud
- Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris Cancer Institute CARPEM, Department of Geriatric Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Agathe Raynaud-Simon
- Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Hôpital Bichat, Department of Geriatric Medicine, Paris, France
| | - Caroline Thomas
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine, Paris, France
| | - Jacques Boddaert
- Sorbonne Université, INSERM UMR1135, Centre d’immunologie et des Maladies Infectieuses, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine, Paris, France
| | - Lorène Zerah
- Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Pitié Salpêtrière, Department of Geriatric Medicine, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Hélène Vallet
- Address correspondence to: Hélène Vallet, MD, PhD, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Hôpital Saint Antoine, Department of Geriatric Medicine, 184 rue du Faubourg Saint Antoine, Paris 75012, France. E-mail:
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Heiberg KE, Heggestad AKT, Jøranson N, Lausund H, Breievne G, Myrstad M, Ranhoff AH, Walle-Hansen MM, Bruun-Olsen V. 'Brain fog', guilt, and gratitude: experiences of symptoms and life changes in older survivors 6 months after hospitalisation for COVID-19. Eur Geriatr Med 2022. [PMID: 35267190 DOI: 10.1007/s41999-022-00630-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Aim The aim of the study is to explore older participants’ experiences of symptoms and life changes approximately 6 months after hospitalisation for COVID-19. Findings The participants experienced various persistent physical and cognitive symptoms. At the same time, they experienced gratitude for having survived and for having achieved new life perspectives. Message Despite suffering from the post-COVID-19 condition the older adults’ coping resources helped them achieve new life perspectives. Purpose Several of those who have been infected with COVID-19 suffer from the post-COVID-19 condition months after the acute infection. Little is known about how older survivors have experienced the consequences and how these have affected their lives. The aim of this study was to explore how older survivors experienced post-COVID-19 condition and life changes approximately 6 months after hospitalisation for COVID-19. Methods The study had an explorative and descriptive design. Semi-structured interviews were performed with 17 participants from two local hospitals, 11 men and 6 women, aged 60 years and older (age range 60–96), approximately 6 months after hospitalisation for COVID-19. A thematic descriptive analysis inspired by Braun and Clarke was used. Results Two main themes and seven subthemes were revealed. The main themes were: From few to various persistent symptoms and Existential thoughts and reflections. Most of the participants experienced various physical and/or cognitive symptoms, such as reduced physical fitness, heavy breathing, fatigue, and ‘brain fog’. On the other hand, they also experienced guilt and gratitude for having survived. The recognition of having achieved other life perspectives was also present. Conclusion Six months after undergone COVID-19 the participants still experienced various distressing symptoms, which were in line with larger studies. The novel findings of this study were connected to the existential area, where the patients’ thoughts and reflections of guilt, gratitude, and new life perspectives were revealed. These findings are important for health professionals to consider when treating patients after COVID-19.
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Carter B, Ramsay EA, Short R, Goodison S, Lumsden J, Khan A, Braude P, Vilches-Moraga A, Quinn TJ, McCarthy K, Hewitt J, Myint PK, Bruce E, Einarsson A, McCrorie K, Aggrey K, Bilan J, Hartrop K, Murphy C, McGovern A, Clini E, Guaraldi G, Verduri A, Bisset C, Alexander R, Kelly J, Murphy C, Mutasem TEJ, Singh S, Paxton D, Harris W, Moug S, Galbraith N, Bhatti E, Edwards J, Duffy S, Espinoza MFR, Kneen T, Dafnis A, Allafi H, Vidal MN, Price A, Pearce L, Lee T, Sangani S, Garcia M, Davey C, Jones S, Lunstone K, Cavenagh A, Silver C, Telford T, Simmons R. Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatr 2022; 22:119. [PMID: 35151257 PMCID: PMC8840680 DOI: 10.1186/s12877-022-02782-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality. Methods Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (February–June 2020 and October 2020–March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics. Results One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73–86] years) were included in the study. 28-day mortality was 42.3% (n = 742). 48% (n = 801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥ 60 [Stage 1&2]): eGFR 45–59 [Stage 3a] aHR = 1.26 (95%CI 1.02–1.55); eGFR 30–44 [Stage 3b] aHR = 1.41 (95%CI 1.14–1.73); eGFR 1–29 [Stage 4&5] aHR = 1.42 (95%CI 1.13–1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR) = 1.18 (95%CI 0.88–1.58), Stage 3b aOR = 1.40 (95%CI 1.03–1.89); and Stage 4&5 aOR = 1.65 (95%CI 1.16–2.35). Conclusion eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02782-5.
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Golota AS, Kamilova ТA, Makarenko SV, Sarana AM, Sherbak SG. REHABILITATION DURING THE COVID-19 PANDEMIC. Journal of Clinical Practice. [DOI: 10.17816/clinpract79364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The COVID-19 pandemic has affected the entire healthcare system, from emergency care, intensive care units, internal medicine wards, outpatient care to home care. The pandemic continues and brings a large number of patients with COVID-19-associated postintensive care syndrome suffering from physical, mental and cognitive impairments that threaten their return to normal life. The complexity and severity of illness in patients recovering from severe COVID-19 requires a coordinated and systematic approach to be applied as early as possible during the recovery phase. Considering the multiorgan dysfunction, debility, pulmonary, neurological, neuromuscular and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with COVID-19. Complications of COVID-19 can be reduced by 1) multidisciplinary rehabilitation, which begins early and continues throughout the hospital stay, 2) providing patient/family education for self-care after discharge from inpatient rehabilitation, and 3) continuing rehabilitation care in the outpatient setting, and at home either in person or with the help of telerehabilitation.
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19
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Le Gentil S, Prampart S, Karakachoff M, Bureau ML, Chapelet G, De Decker L, Rouaud A, Boureau AS. Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study. J Nutr Health Aging 2022; 26:896-903. [PMID: 36156682 PMCID: PMC9470507 DOI: 10.1007/s12603-022-1845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/15/2022] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Among patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia. DESIGN AND SETTING This case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls. RESULTS 132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039); prior fall (OR=2.08, p=0.012); malnutrition (OR=1.97, p=0.018); length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049). CONCLUSION COVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population.
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Affiliation(s)
- S Le Gentil
- Anne-Sophie Boureau, Department of Geriatrics, University Hospital, 44093 Nantes, France; phone: +33 2-40-16-50-46;
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20
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Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Affiliation(s)
- A Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
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22
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Cereda G, Ciappolino V, Boscutti A, Cantù F, Enrico P, Oldani L, Delvecchio G, Brambilla P. Zinc as a Neuroprotective Nutrient for COVID-19-Related Neuropsychiatric Manifestations: A Literature Review. Adv Nutr 2021; 13:66-79. [PMID: 34634109 PMCID: PMC8524565 DOI: 10.1093/advances/nmab110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/25/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
The outbreak of the pandemic associated with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) led researchers to find new potential treatments, including nonpharmacological molecules such as zinc (Zn2+). Specifically, the use of Zn2+ as a therapy for SARS-CoV-2 infection is based on several findings: 1) the possible role of the anti-inflammatory activity of Zn2+ on the aberrant inflammatory response triggered by COronaVIrus Disease 19 (COVID-19), 2) properties of Zn2+ in modulating the competitive balance between the host and the invading pathogens, and 3) the antiviral activity of Zn2+ on a number of pathogens, including coronaviruses. Furthermore, Zn2+ has been found to play a central role in regulating brain functioning and many disorders have been associated with Zn2+ deficiency, including neurodegenerative diseases, psychiatric disorders, and brain injuries. Within this context, we carried out a narrative review to provide an overview of the evidence relating to the effects of Zn2+ on the immune and nervous systems, and the therapeutic use of such micronutrients in both neurological and infective disorders, with the final goal of elucidating the possible use of Zn2+ as a preventive or therapeutic intervention in COVID-19. Overall, the results from the available evidence showed that, owing to its neuroprotective properties, Zn2+ supplementation could be effective not only on COVID-19-related symptoms but also on virus replication, as well as on COVID-19-related inflammation and neurological damage. However, further clinical trials evaluating the efficacy of Zn2+ as a nonpharmacological treatment of COVID-19 are required to achieve an overall improvement in outcome and prognosis.
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Affiliation(s)
- Guido Cereda
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Filippo Cantù
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Enrico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Watne LO, Tonby K, Holten AR, Olasveengen TM, Romundstad LG, Neerland BE. Delirium is common in patients hospitalized with COVID-19. Intern Emerg Med 2021; 16:1997-2000. [PMID: 33830418 PMCID: PMC8026811 DOI: 10.1007/s11739-021-02715-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/14/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Nydalen, Post box 4950, 0424, Oslo, Norway.
| | - Kristian Tonby
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aleksander Rygh Holten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Theresa Mariero Olasveengen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | | | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Nydalen, Post box 4950, 0424, Oslo, Norway
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Waechter C. Manifestations cliniques et paracliniques de la COVID-19, diagnostic virologique. NPG Neurologie - Psychiatrie - Gériatrie 2021; 21:297-303. [DOI: 10.1016/j.npg.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Des formes parfaitement asymptomatiques aux formes de COVID-19 sévères, nécessitant une prise en charge en Service de réanimation, la COVID-19 est aujourd’hui mieux décrite. Entre 30 et 50 % des patients resteront asymptomatiques et la majorité des malades symptomatiques développeront les signes d’une infection virale des voies respiratoires (fièvre, toux, asthénie). La particularité de la COVID-19 réside dans le large éventail de symptômes associés et de l’évolution, dans environ 5 % des cas, vers un syndrome de détresse respiratoire aiguë. Si l’âge demeure le facteur de risque principal de développer une forme sévère de COVID-19, il ne semble pas exister de tableau clinique spécifique au sujet âgé, pour qui l’expression de la maladie se rapproche de l’adulte jeune.
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Poulain M, Chambre D, Pes GM. Centenarians exposed to the Spanish flu in their early life better survived to COVID-19. Aging (Albany NY) 2021; 13:21855-21865. [PMID: 34570724 PMCID: PMC8507269 DOI: 10.18632/aging.203577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
Background: Although it is known that mortality due to COVID-19 increases progressively with age, the probability of dying from this serious infection among the oldest-old population is little known, and controversial data are found in literature. Methods: We examine the mortality by year and month of birth of Belgians who had turned 100 during the current COVID-19 pandemic and whose birth fell on the years around the end the First World War and the outbreak of the H1N1 "Spanish flu" pandemic. Findings: The COVID-19 mortality of the "older" centenarians is significantly lower than that of "younger" centenarians, and this difference between the two groups reaches a maximum on August 1, 1918 as the discriminating cut-off date of birth. Having excluded the plausible impact of the end of WWI it becomes clear that this date corresponds to the time of reporting the first victims of the Spanish flu pandemic in Belgium. Interpretation: In this study, the striking temporal coincidence between the outbreak of the Spanish flu epidemic and the birth of the cohorts characterized by greater fragility towards COVID-19 in 2020 strongly suggests a link between exposure to 1918 H1N1 pandemic influenza and resistance towards 2020 SARS-Cov-2. It can be speculated that the lifetime persistence of cross-reactive immune mechanisms has enabled centenarians exposed to the Spanish flu to overcome the threat of COVID-19 a century later.
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Affiliation(s)
- Michel Poulain
- IACCHOS Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | | | - Giovanni Mario Pes
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Canouï-Poitrine F, Rachas A, Thomas M, Carcaillon-Bentata L, Fontaine R, Gavazzi G, Laurent M, Robine JM. Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study. Age Ageing 2021; 50:1473-1481. [PMID: 33984133 PMCID: PMC8406878 DOI: 10.1093/ageing/afab098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement. METHODS We studied a cohort of 494,753 adults in 6,515 NHs in France exposed to COVID-19 pandemic (from 1 March to 31 May 2020) and compared with the 2014-2019 cohorts using data from the French National Health Data System. The main outcome was death. Excess deaths and standardized mortality ratios (SMRs) were estimated. RESULT There were 13,505 excess deaths. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than females (SMR: 1.51 and 1.38) and decreased with increasing age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94 and 1.31 for 95 or over; males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94 and 1.41 for 95 or over). No mortality displacement effect was observed up until 30 August 2020. By extrapolating to all NH residents nationally (N = 570,003), we estimated that they accounted for 51% of the general population excess deaths (N = 15,114 out of 29,563). CONCLUSION NH residents accounted for half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger than older residents.
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Affiliation(s)
- Florence Canouï-Poitrine
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Public Health Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Antoine Rachas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | - Martine Thomas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | | | - Roméo Fontaine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
| | - Gaëtan Gavazzi
- Geriatric Department, Grenoble Alpes University Hospital, F-38000 Grenoble, France
- University of Grenoble-Alpes, GREPI TIMC-IMAG, CNRS UMR 552, F-38000 Grenoble, France
| | - Marie Laurent
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Geriatric Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Jean-Marie Robine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
- Univ Paris, INSERM, CNRS, EHSS, CERMES3, F-75000 Paris, France
- Univ Montpellier, EPHE, INSERM, MMDN, F-34000 Montpellier, France
- PSL Research University, F-75000 Paris, France
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Hacquin A, Perret M, Manckoundia P, Bonniaud P, Beltramo G, Georges M, Putot A. High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure. J Clin Med 2021; 10:3515. [PMID: 34441811 DOI: 10.3390/jcm10163515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022] Open
Abstract
We aimed to compare the mortality and comfort associated with high-flow nasal cannula oxygenation (HFNCO) and high-concentration mask (HCM) in older SARS-CoV-2 infected patients who were hospitalized in non-intensive care units. In this retrospective cohort study, we included all consecutive patients aged 75 years and older who were hospitalized for acute respiratory failure (ARF) in either an acute geriatric unit or an acute pulmonary care unit, and tested positive for SARS-CoV-2. We compared the in-hospital prognosis between patients treated with HFNCO and patients treated with HCM. To account for confounders, we created a propensity score for HFNCO, and stabilizing inverse probability of treatment weighting (SIPTW) was applied. From March 2020 to January 2021, 67 patients (median age 87 years, 41 men) were hospitalized with SARS-CoV-2-related ARF, of whom 41 (61%) received HFNCO and 26 (39%) did not. Age and comorbidities did not significantly differ in the two groups, whereas clinical presentation was more severe in the HFNCO group (NEW2 score: 8 (5-11) vs. 7 (5-8), p = 0.02, and Sp02/Fi02: 88 (98-120) vs. 117 (114-148), p = 0.03). Seven (17%) vs. two (5%) patients survived at 30 days in the HFNCO and HCM group, respectively. Overall, after SIPTW, HFNCO was significantly associated with greater survival (adjusted hazard ratio (AHR) 0.57, 95% CI 0.33-0.99; p = 0.04). HFNCO use was associated with a lower need for morphine (AHR 0.39, 95% CI 0.21-0.71; p = 0.005), but not for midazolam (AHR 0.66, 95% CI 0.37-1.19; p = 0.17). In conclusion, HFNCO use in non-intensive care units may reduce mortality and discomfort in older inpatients with SARS-CoV-2-related ARF.
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Abstract
Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2-17.2), fatigue 33.6% (29.5-37.8), olfactory dysfunction 26.4% (21.8-31.3), gustatory dysfunction 27.2% (22.3-32.3), vomiting 6.7% (5.5-8.0), nausea 9.8% (8.1-11.7), dizziness 6.7% (4.7-9.1), myalgia 21.4% (18.8-24.1), seizure 4.05% (2.5-5.8), cerebrovascular diseases 9.9% (6.8-13.4), sleep disorders 14.9% (1.9-36.8), altered mental status 17.1% (12.3-22.5), neuralgia 2.4% (0.8-4.7), arthralgia 19.9% (15.3-25.0), encephalopathy 23.5% (14.3-34.1), encephalitis 0.6% (0.2-1.3), malaise 38.3% (24.7-52.9), confusion 14.2% (6.9-23.5), movement disorders 5.2% (1.7-10.4), and Guillain-Barre syndrome 6.9% (2.3-13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.
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Affiliation(s)
- Vitalakumar D
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
| | - Ankita Sharma
- Department of Biotechnology, National
Institute of Pharmaceutical Education and Research (NIPER)-Raeberali,
Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical Research, Delhi
Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi
Pharmaceutical Sciences & Research University (DPSRU), New Delhi
110017, India
| | - S. J. S. Flora
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
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Houdre J, Laaraj F, Sorrel Dejerine A, Brunetti N, Neiss M, Vétillard A, Mary M, Simon P, Colas M, Houenou-quenum N, Souques C, Trivalle C, Guichardon M, Collarino R, Baudouin E, Duron E. Caractéristiques et mortalité des patients gériatriques infectés au Sars-CoV2 : description et comparaison des patients hospitalisés en unité dédiée COVID et de ceux en unités Alzheimer. NPG Neurologie - Psychiatrie - Gériatrie 2021; 21:255-261. [DOI: 10.1016/j.npg.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Objectif Matériel et méthode Résultats Conclusion
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31
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Mendes A, Herrmann FR, Périvier S, Gold G, Graf CE, Zekry D. Delirium in Older Patients With COVID-19: Prevalence, Risk Factors, and Clinical Relevance. J Gerontol A Biol Sci Med Sci 2021; 76:e142-e146. [PMID: 33539505 PMCID: PMC7929187 DOI: 10.1093/gerona/glab039] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Delirium prevalence increases with age and is associated with poor outcomes. We aimed to investigate the prevalence and risk factors for delirium in older patients hospitalized with COVID-19, as well as its association with length of stay and mortality. Method This was a retrospective study of patients aged 65 years and older hospitalized with COVID-19. Data were collected from computerized medical records and all patients had delirium assessment at admission. Risk factors for delirium as well as the outcomes mentioned above were studied by 2-group comparison, logistic regression, and Cox proportional hazard models. Results Of a total of 235 Caucasian patients, 48 (20.4%) presented with delirium, which was hypoactive in 41.6% of cases, and hyperactive and mixed in 35.4% and 23.0%, respectively. Patients with cognitive impairment had a nearly 4 times higher risk of developing delirium compared to patients who were cognitively normal before SARS-CoV-2 infection (odds ratio 3.7; 95% CI: 1.7–7.9, p = .001). The presence of delirium did not modify the time from symptoms’ onset to hospitalization or the length of stay in acute care, but it was associated with an increased risk of dying (hazard ratio 2.1; 95% CI: 1.2–3.7, p = .0113). Conclusion Delirium was a prevalent condition in older people admitted with COVID-19 and preexisting cognitive impairment was its main risk factor. Delirium was associated with higher in-hospital mortality. These results highlight the importance of early recognition of delirium especially when premorbid cognitive comorbidities are present.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Switzerland
| | | | - Samuel Périvier
- Division of Geriatrics, University Hospitals of Geneva, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, University Hospitals of Geneva, Switzerland
| | - Christophe E Graf
- Division of Internal Medicine and Rehabilitation, University Hospitals of Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, University Hospitals of Geneva, Switzerland
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32
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Piniella-Ruiz E, Bellver-Álvarez MT, Mestre-Gómez B, Escolano-Fernández B, Vinat-Prado S, Cabezas-Olea R, Acedo-Gutiérrez MS, Akasbi-Montalvo M, Ryan-Murua P, Bustamante-Fermosel A, Muñoz-Rivas N, Santamaría-García C, Pardo-Guimerá V, Ulla-Anés M, Franco-Moreno A, Torres-Macho J. Impact of Systemic Corticosteroids on Mortality in Older Adults With Critical COVID-19 Pneumonia. J Gerontol A Biol Sci Med Sci 2021; 76:e127-e132. [PMID: 33711156 PMCID: PMC7989632 DOI: 10.1093/gerona/glab074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Background The most susceptible population group to critical and fatal coronavirus disease 2019 (COVID-19) is older adults. In SARS-CoV-2 infection, the host immune response is thought to play a key role in the pathophysiological effects of lung damage. Therefore, corticosteroid therapy could modulate inflammation-mediated pulmonary injury and thereby reduce progression to severe respiratory failure and death. The aim of this study was to analyse the safety and clinical efficacy of corticosteroid therapy in older adults with severe COVID-19 pneumonia. Method We reviewed the clinical records of confirmed COVID-19 patients aged 75 years or older admitted to our hospital over a three months period (March 1, to May 31, 2020). A total of 143 patients were included in the study cohort. From 2 April, 2020, in accordance with World Health Organization (WHO) guidance on COVID-19, our hospital protocol added corticosteroid for COVID-19 treatment. We compared in-hospital mortality among patients with critical COVID-19 who received corticosteroids therapy and those who did not. Results 88 patients (61.5%) were treated with corticosteroids, and 55 patients (38.4%) were not. Both groups were similar in baseline characteristics. The median age was 85 years (IQR, 82–89), and 61.5% (88/143) were male. In-hospital mortality was lower in the corticosteroid group (68.2%) compared with patients in the non-corticosteroid group (81.8%). Treatment with corticosteroids was an independent survival factor (HR=0.61; 95% CI, 0.41–0.93; P=0.006). Conclusions In critically ill older adults with COVID-19 pneumonia, the use of corticosteroid treatment resulted in lower mortality without severe adverse events.
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Affiliation(s)
- Esther Piniella-Ruiz
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | | | - Beatriz Mestre-Gómez
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Belén Escolano-Fernández
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Sara Vinat-Prado
- Emergency Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Rita Cabezas-Olea
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | | | - Mirian Akasbi-Montalvo
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Pablo Ryan-Murua
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Ana Bustamante-Fermosel
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | | | - Virginia Pardo-Guimerá
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Mariano Ulla-Anés
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Anabel Franco-Moreno
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Juan Torres-Macho
- Department of Internal Medicine, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
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Putot A, Bouiller K, Laborde C, Gilis M, Févre A, Hacquin A, Manckoundia P, Hoefler F, Bermejo M, Mendes A, Serratrice C, Prendki V, Sanchez S. Association between Early Antibiotic Therapy and In-Hospital Mortality among Older Patients with SARS-CoV-2 Pneumonia. J Gerontol A Biol Sci Med Sci 2021; 77:e115-e123. [PMID: 34272847 PMCID: PMC8406862 DOI: 10.1093/gerona/glab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is uncertain whether antibiotic therapy should be started in SARS CoV-2 pneumonia. We aimed to investigate the association between early antibiotic therapy and the risk of in-hospital mortality in older patients. Methods We performed a retrospective international cohort study (ANTIBIOVID) in five COVID-19 geriatric units in France and Switzerland. Among 1,357 consecutive patients aged 75 or more hospitalised and testing positive for SARS-CoV-2, 1072 had a radiologically confirmed pneumonia, of which 914 patients were still alive and hospitalized at 48 hours. 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 early antibiotic therapy and in-hospital 30-day mortality, SIPTW-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed. Results Of the 914 patients with SARS-CoV-2 pneumonia, median age of 86, 428 (46.8%) received antibiotics in the first 48 hours after diagnosis. Among these patients, 147 (34.3%) died in hospital within one month vs 118 patients (24.3%) with no early antibiotic treatment. After SIPTW, early antibiotic treatment was not significantly associated with mortality (adjusted hazard ratio, 1.23; 95% CI, 0.92-1.63; P = .160). Microbiologically confirmed superinfections occurred rarely in both groups (bacterial pneumonia: 2.5% vs 1.5%, P = .220; blood stream infection: 8.2% vs 5.2%, P = .120; Clostridioides difficile colitis: 2.4% vs 1.0%, P = .222). Conclusions In a large multicentre cohort of older inpatients with SARS-CoV-2 pneumonia, early antibiotic treatment did not appear to be associated with an improved prognosis.
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Affiliation(s)
- Alain Putot
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, Besançon University Hospital, Besançon, France
| | - Caroline Laborde
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Marine Gilis
- Department of Geriatrics, Besançon University Hospital, Besançon, France
| | - Amélie Févre
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Arthur Hacquin
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Florence Hoefler
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Messaline Bermejo
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Sanchez
- Department of Clinical Research, Troyes Hospital Centre, Troyes, France
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Ticinesi A, Nouvenne A, Prati B, Guida L, Parise A, Cerundolo N, Bonaguri C, Aloe R, Guerra A, Meschi T. The Clinical Significance of Procalcitonin Elevation in Patients over 75 Years Old Admitted for COVID-19 Pneumonia. Mediators Inflamm 2021; 2021:5593806. [PMID: 34326704 DOI: 10.1155/2021/5593806] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/28/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
Aim To investigate the clinical significance of procalcitonin (PCT) elevation on hospital admission for coronavirus disease-19 (COVID-19) and its association with mortality in oldest old patients (age > 75 years). Methods The clinical records of 1074 patients with chest high-resolution computed-tomography (HRCT) positive for interstitial pneumonia and symptoms compatible for COVID-19, hospitalized in medical wards during the first pandemic wave in a single academic center in Northern Italy, were retrospectively analyzed. All patients had serum PCT testing performed within six hours from admission. Information on COVID-19-related symptoms, comorbidities, drugs, autonomy in daily activities, respiratory exchanges, other routine lab tests, and outcomes were collected. Clinical characteristics were compared across different admission PCT levels and ages. The association of admission PCT with mortality was tested separately in participants aged > 75 and ≤75 years old by stepwise multivariate Cox regression model with forward selection. Results With increasing classes of PCT levels (<0.05, 0.05-0.49, 0.5-1.99, and ≥2 ng/ml), there was a significant trend (P < 0.0001) towards older age, male gender, wider extension of lung involvement on HRCT, worse respiratory exchanges, and several other laboratory abnormalities. Each incremental PCT class was associated with increased risk of hospital death at multivariate models in subjects older than 75 (hazard ratio for PCT ≥ 2 vs. <0.05 ng/ml: 30.629, 95% confidence interval 4.176-224.645, P = 0.001), but not in subjects aged 75 or younger. Conclusions In patients admitted for COVID-19, PCT elevation was associated with several clinical, radiological, and laboratory characteristics of disease severity. However, PCT elevation was strongly associated with hospital mortality only in oldest old subjects (age > 75).
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Couderc AL, Correard F, Hamidou Z, Nouguerede E, Arcani R, Weiland J, Courcier A, Caunes P, Clot-Faybesse P, Gil P, Berard C, Miola C, Berbis J, Villani P, Daumas A. Factors Associated With COVID-19 Hospitalizations and Deaths in French Nursing Homes. J Am Med Dir Assoc 2021; 22:1581-1587.e3. [PMID: 34237258 DOI: 10.1016/j.jamda.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/30/2021] [Accepted: 06/13/2021] [Indexed: 01/10/2023]
Abstract
Objectives To describe the clinical characteristics and management of residents in French nursing homes with suspected or confirmed coronavirus disease 2019 (COVID-19) and to determine the risk factors for COVID-19–related hospitalization and death in this population. Design A retrospective multicenter cohort study. Setting and Participants Four hundred eighty nursing home residents with suspected or confirmed COVID-19 between March 1 and May 20, 2020, were enrolled and followed until June 2, 2020, in 15 nursing homes in Marseille’s greater metropolitan area. Methods Demographic, clinical, laboratory, treatment type, and clinical outcome data were collected from patients’ medical records. Multivariable analysis was used to determine factors associated with COVID-19–related hospitalization and death. For the former, the competing risk analysis—based on Fine and Gray’s model—took death into account. Results A total of 480 residents were included. Median age was 88 years (IQR 80-93), and 330 residents were women. A total of 371 residents were symptomatic (77.3%), the most common symptoms being asthenia (47.9%), fever or hypothermia (48.1%), and dyspnea (35.6%). One hundred twenty-three patients (25.6%) were hospitalized and 96 (20%) died. Male gender [specific hazard ratio (sHR) 1.63, 95% confidence interval (CI) 1.12-2.35], diabetes (sHR 1.69, 95% CI 1.15-2.50), an altered level of consciousness (sHR 2.36, 95% CI 1.40-3.98), and dyspnea (sHR 1.69, 95% CI 1.09-2.62) were all associated with a greater risk of COVID-19–related hospitalization. Male gender [odds ratio (OR) 6.63, 95% CI 1.04-42.39], thermal dysregulation (OR 2.64, 95% CI 1.60-4.38), falls (2.21 95% CI 1.02-4.75), and being aged >85 years (OR 2.36, 95% CI 1.32-4.24) were all associated with increased COVID-19–related mortality risk, whereas polymedication (OR 0.46, 95% CI 0.27-0.77) and preventive anticoagulation (OR 0.46, 95% CI 0.27-0.79) were protective prognostic factors. Conclusions and Implications Male gender, being aged >85 years old, diabetes, dyspnea, thermal dysregulation, an altered level of consciousness, and falls must all be considered when identifying and protecting nursing home residents who are at greatest risk of COVID-19–related hospitalization and death.
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Forget MF, Del Degan S, Leblanc J, Tannous R, Desjardins M, Durand M, Vu TTM, Nguyen QD, Desmarais P. Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study. Clin Interv Aging 2021; 16:1223-1230. [PMID: 34234422 PMCID: PMC8242147 DOI: 10.2147/cia.s315405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). Patients and Methods This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. Results A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase. Conclusion In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.
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Affiliation(s)
- Marie-France Forget
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sophie Del Degan
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julie Leblanc
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rita Tannous
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michaël Desjardins
- Department of Medicine, Division of Infectious Disease, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thien Tuong Minh Vu
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Gálvez-Barrón C, Arroyo-Huidobro M, Miňarro A, Añaños G, Chamero A, Martín M, Gris C, Avalos JL, Capielo AM, Ventosa E, Tremosa G, Rodríguez-Molinero A. COVID-19: Clinical Presentation and Prognostic Factors of Severe Disease and Mortality in the Oldest-Old Population: A Cohort Study. Gerontology 2021; 68:30-43. [PMID: 33853067 PMCID: PMC8089423 DOI: 10.1159/000515159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/11/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction The oldest-old population (80 years or older) has the highest lethality from COVID-19. There is little information on the clinical presentation and specific prognostic factors for this group. This trial evaluated the clinical presentation and prognostic factors of severe disease and mortality in the oldest-old population. Methods This is an ambispective cohort study of oldest-old patients hospitalized for respiratory infection associated with COVID-19 and with a positive test by RT-PCR. The clinical presentation and the factors associated with severe disease and mortality were evaluated (logistic regression). All patients were followed up until discharge or death. Results A total of 103 patients (59.2% female) were included. The most frequent symptoms were fever (68.9%), dyspnoea (60.2%), and cough (39.8%), and 11.7% presented confusion. Fifty-nine patients (57.3%) presented severe disease, and 59 died, with 43 patients (41.7%) presenting both of these. In the multivariate analysis, female sex (odds ratio [OR] 0.31, 95% confidence interval [95% CI] 0.13–0.73, p 0.0074) and serum lactate dehydrogenase (LDH) (OR 2.55, 95% CI 1.21–5.37, p 0.0139) were associated with severe disease, and serum sodium was associated with mortality (OR 3.12, 95% CI 1.18–8.26, p 0.0222). No chronic disease or pharmacological treatment was associated with worse outcomes. Conclusions The typical presenting symptoms of respiratory infection in COVID-19 are less frequent in the oldest-old population. Male sex and LDH level are associated with severe disease, and the serum sodium level is associated with mortality in this population.
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Affiliation(s)
- César Gálvez-Barrón
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain.,Department of Geriatrics, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Marta Arroyo-Huidobro
- Department of Geriatrics, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Antonio Miňarro
- Department of Genetics, Microbiology and Statistics, School of Biology, University of Barcelona, Barcelona, Spain
| | - Gemma Añaños
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain.,Department of Geriatrics, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Antonio Chamero
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Mireia Martín
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Clara Gris
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Jose L Avalos
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Anna M Capielo
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Ester Ventosa
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Gemma Tremosa
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
| | - Alejandro Rodríguez-Molinero
- Research Area, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain.,Department of Geriatrics, Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
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Abstract
The high infectivity and severity of SARS-CoV-2 infection (COVID-19), and our limited understanding of the biology of the novel coronavirus, as well as the lack of an effective treatment for COVID-19, have created a global pandemic. Those most likely to become seriously ill with COVID-19 are adults, especially the elderly and those who are already weak or sick. At present, a specific drug for treatment of COVID-19 has not been developed. This, combined with the typical coexistence of a variety of chronic diseases in elderly patients, makes treatment challenging at present. In addition, for elderly patients, COVID-19 isolation measures during the epidemic can easily lead to psychological problems. Thus, how to manage elderly patients has become a focus of social attention in the current circumstances. This article reviews the effects of COVID-19 and makes management suggestions for elderly patients during this epidemic period. In addition to the elderly, critically ill people are also highly susceptible to this novel coronavirus. For elderly COVID-19 patients, antiviral therapy, immune regulation, and even auxiliary respiratory therapy can be given after a comprehensive evaluation of the disease. With the approval and use of COVID-19 vaccines, it is reasonable to expect that we can conquer SARS-CoV-2.
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Affiliation(s)
- Qiaoyun Li
- Graduate School, Qinghai University, Xining, Qinghai, P.R. China
| | - Chengyu Zhao
- Department of Geriatrics, Affiliated Hospital of Qinghai University, Xining, Qinghai, P.R. China
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Pizarro-Pennarolli C, Sánchez-Rojas C, Torres-Castro R, Vera-Uribe R, Sanchez-Ramirez DC, Vasconcello-Castillo L, Solís-Navarro L, Rivera-Lillo G. Assessment of activities of daily living in patients post COVID-19: a systematic review. PeerJ 2021; 9:e11026. [PMID: 33868804 PMCID: PMC8034364 DOI: 10.7717/peerj.11026] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease has provoked much discussion since its first appearance. Despite it being widely studied all over the world, little is known about the impact of the disease on functional ability related to performing activities of daily living (ADL) in patients post COVID-19 infection. Objectives To understand the impact of COVID-19 on ADL performance of adult patients and to describe the common scales used to assess performance of ADL on patients post-COVID-19. Methods A systematic review was conducted. We included studies that applied a physical capacity test in COVID-19 patients, post-infection. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results A total of 1,228 studies were included, after removing duplicates, 1,005 abstracts were screened and of those 983 were excluded. A final number of nine studies which met the eligibility criteria were included. The findings revealed worsening of physical function and ADL performance in all patients post COVID-19 infection. Conclusion All included studies found a reduction of ADL beyond the test or scale used, revealing a vital worsening of functional ability in ADL performance and consequently loss of independence in COVID-19 patients after the acute phase of infection. Functional ability status previous to COVID-19 is crucial for predicting the severity of the disease and mortality. Barthel Index and ADL score were the most used assessment tools across subjects with different intrinsic capacity and context levels.
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Affiliation(s)
| | - Carlos Sánchez-Rojas
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, España
| | - Roberto Vera-Uribe
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, España
| | - Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, España
| | - Lilian Solís-Navarro
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gonzalo Rivera-Lillo
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Research and Development Unit, Clínica Los Coihues, Santiago, Chile.,Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr 2021; 21:199. [PMID: 33752614 PMCID: PMC7983098 DOI: 10.1186/s12877-021-02140-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background Older people are particularly vulnerable to severe COVID-19. Little is known about long-term consequences of COVID-19 on health-related quality of life (HR-QoL) and functional status in older people, and the impact of age in this context. We aimed to study age-related change in health-related quality of life, functional decline and mortality among older patients 6 months following hospitalisation due to COVID-19. Methods This was a cohort study including patients aged 60 years and older admitted to four general hospitals in South-Eastern Norway due to COVID-19, from March 1 up until July 1, 2020. Patients who were still alive were invited to attend a six-month follow-up. Change in HR-QoL and functional status compared to before the COVID-19 hospitalisation were assessed using the EuroQol 5-dimensional-5 levels questionnaire (EQ. 5D-5L). A change in visual analogue scale (VAS) score of 7 or more was considered clinically relevant. Results Out of 216 patients aged 60 years and older that were admitted to hospital due to COVID-19 during the study period, 171 were still alive 180 days after hospital admission, and 106 patients (62%) attended the six-month follow-up. Mean age was 74.3 years, 27 patients (26%) had experienced severe COVID-19. Fifty-seven participants (54%) reported a decrease in the EQ. 5D-5L VAS score after 6 months, with no significant difference between persons aged 75 years and older compared to younger. Seventy participants (66%) reported a negative change in any of the dimensions of the EQ. 5D-5L, with impaired ability to perform activities of daily life (35%), reduced mobility (33%) and having more pain or discomfort (33%) being the most commonly reported changes. Forty-six participants (43%) reported a negative change in cognitive function compared to before the COVID-19 hospitalisation. Six-month mortality was 21%, and increased with increasing age. Conclusions More than half of the patients reported a negative change in HR-QoL 6 months following hospitalisation due to COVID-19, and one out of three experienced a persistently impaired mobility and ability to carry out activities of daily living. The results suggest awareness of long-term functional decline in older COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02140-x.
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Affiliation(s)
- M M Walle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.
| | - A H Ranhoff
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - M Mellingsæter
- Department of Geriatric Medicine, Akershus University Hospital, Lørenskog, Norway
| | - M S Wang-Hansen
- Department of Geriatric Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - M Myrstad
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway.,Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
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41
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Frohnhofen H, Stieglitz S. [Pneumonia in old age]. Pneumologe (Berl) 2021; 18:174-181. [PMID: 33746676 PMCID: PMC7963464 DOI: 10.1007/s10405-021-00388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/08/2022]
Abstract
Die Pneumonie ist eine bei alten Menschen häufige und schwere Erkrankung. Sie steht in dieser Patientengruppe an vierter Stelle der zum Tode führenden Erkrankungen. Die Diagnose kann oft aufgrund einer atypischen klinischen Präsentation schwierig sein. Daher sollte bei jeder Verschlechterung eines alten Menschen ursächlich auch an eine Pneumonie gedacht werden. Geriatrische Probleme wie Gebrechlichkeit und physische und psychische Einschränkungen sollten ebenso erfasst werden wie die soziale Situation, da alle diese Faktoren prognoserelevant sind. Prognostisch ungünstiger verlaufen Pneumonien, die im Pflegeheim oder von Pflegebedürftigen erworben wurden. Sie gelten zwar als ambulant erworben, sollten dennoch besonders beachtet werden. Die Behandlung unterscheidet sich nicht grundsätzlich von der Behandlung jüngerer Patient, sollte aber besondere Situationen wie den in einer Patientenverfügung festgelegten Patientenwunsch bei der Therapieplanung berücksichtigen. Gerade ältere Menschen zeigen unter einer COVID(coronavirus disease)-19-Infektion oft atypische klinische Bilder, sodass bei akuten Veränderungen im Alter auch daran zu denken ist.
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Affiliation(s)
- Helmut Frohnhofen
- Fakultät für Gesundheit Department Humanmedizin, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448 Witten, Deutschland.,Universitätklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Deutschland
| | - Sven Stieglitz
- Klinik für Pneumologie, Allergologie, Schlaf- und Intensivmedizin Petruskrankenhaus Wuppertal, Wuppertal, Deutschland
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42
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Abdelrahman Z, Liu Q, Jiang S, Li M, Sun Q, Zhang Y, Wang X. Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis. Front Pharmacol 2021; 12:607408. [PMID: 33790785 PMCID: PMC8005525 DOI: 10.3389/fphar.2021.607408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern. Objective and Methods: To estimate the efficacy and safety of COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of COVID-19 published from January 21 to September 6, 2020. Results: We included 136 studies that involved 102,345 COVID-19 patients. The most prevalent treatments were antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of lopinavir/ritonavir and Arbidol was the most effective in treating COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of corticosteroids was associated with a small clinical improvement (SMD = -0.40, 95% CI: [-0.85, -0.23]), but with a higher risk of disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of lopinavir/ritonavir, ribavirin, and interferon-β (RR = 0.34, 95% CI: [0.22, 0.54]); hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and lopinavir/ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length. Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events. Dexamethasone was not significant in reducing disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of corticosteroids with antivirals was associated with a better clinical improvement than antivirals alone (SMD = -1.09, 95% CI: [-1.64, -0.53]). Conclusion: Antivirals are safe and effective in COVID-19 treatment. Remdesivir cannot significantly reduce COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events. Corticosteroids could increase COVID-19 severity, but it could be beneficial when combined with antivirals. Our data are potentially valuable for the clinical treatment and management of COVID-19 patients.
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Affiliation(s)
- Zeinab Abdelrahman
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qian Liu
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Shanmei Jiang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Mengyuan Li
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qingrong Sun
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Yue Zhang
- Pinghu Hospital of Shenzhen University, Shenzhen, China
- Futian Hospital for Rheumatic Diseases, Shenzhen, China
- Department of Rheumatology and Immunology, The First Clinical College of Harbin Medical University, Harbin, China
| | - Xiaosheng Wang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
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Ticinesi A, Nouvenne A, Cerundolo N, Parise A, Prati B, Guerra A, Meschi T. Trends of COVID-19 Admissions in an Italian Hub during the Pandemic Peak: Large Retrospective Study Focused on Older Subjects. J Clin Med 2021; 10:jcm10051115. [PMID: 33800020 PMCID: PMC7962097 DOI: 10.3390/jcm10051115] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Older multimorbid frail subjects have been severely involved in the coronavirus disease-19 (COVID-19) pandemic. The aim of this retrospective study is to compare the clinical features and outcomes of patients admitted in different phases of the outbreak in a COVID-19 hospital hub, with a particular focus on age, multimorbidity, and functional dependency. The clinical records of 1264 patients with clinical and radiological features compatible with COVID-19 pneumonia admitted in February-June, 2020, were analyzed, retrieving demographical, clinical, laboratory data, and outcomes. All variables were compared after stratification by the period of admission (first phase: rising slope of pandemic wave; second phase: plateau and falling slope), age, results of the first reverse transcriptase-polymerase chain reaction (RT-PCR) test for detection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), multimorbidity (≥2 chronic diseases), and presence of disability. Factors independently associated with hospital mortality were determined by multivariate forward-selection logistic regression. Patients admitted during the second phase were older, more frequently multimorbid, disabled, and of female gender. However, on admission they exhibited milder respiratory impairment (PaO2/FiO2 268, IQR 174-361, vs. 238, IQR 126-327 mmHg, p < 0.001) and lower mortality (22% vs. 27%, p < 0.001). Age, respiratory exchanges, positive RT-PCR test, number of chronic diseases (odds ratio (OR) 1.166, 95% confidence interval (CI) 1.036-1.313, p = 0.011), and disability (OR 1.927, 95% CI 1.027-3.618, p = 0.022) were positively associated with mortality, while admission during the second phase exhibited an inverse association (OR 0.427, 95% CI 0.260-0.700, p = 0.001). In conclusion, older multimorbid patients were mainly hospitalized during the second phase of the pandemic wave. The prognosis was strongly influenced by the COVID-19 phenotype and period of admission, not just by age, multimorbidity, and disability.
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Affiliation(s)
- Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
- Correspondence: or ; Tel.: +39-0521-703871 or +39-3471845191; Fax: +39-0521702383
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
| | - Angela Guerra
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (N.C.); (A.P.); (B.P.); (A.G.); (T.M.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Couderc AL, Correard F, Nouguerède E, Berbis J, Rey D, Daumas A, Villani P. Centenarians in nursing homes during the COVID-19 pandemic. Aging (Albany NY) 2021; 13:6247-57. [PMID: 33653968 DOI: 10.18632/aging.202743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
Background: Centenarians are known to be successful agers compared to other older adults.Objective: The objective of the present study was to compare coronavirus disease (COVID-19) symptoms and outcomes in centenarians and other residents living in nursing homes. Design-Setting-Subjects-Methods: A retrospective multicenter cohort study was conducted using data from 15 nursing homes in the Marseille area. Older residents with confirmed COVID-19 between March and June 2020 were enrolled. The clinical and biological characteristics, the treatment measures, and the outcomes in residents living in these nursing homes were collected from the medical records. Results: A total of 321 residents were diagnosed with COVID-19 including 12 centenarians. The median age was 101 years in centenarians and 89 years in other residents. The most common symptoms were asthenia and fever. Three centenarians (25%) experienced a worsening of pre-existing depression (vs. 5.5% of younger residents; p = 0.032). Mortality was significantly higher in centenarians than in younger residents (50% vs. 21.3%, respectively; p = 0.031). A quarter of the younger residents and only one centenarian were hospitalized. However, 33.3% of the centenarians received treatment within the context of home hospitalization. Conclusion: Worsening of pre-existing depression seems to be more frequent in centenarians with COVID-19 in nursing homes. This population had a higher mortality rate but a lower hospitalization rate than younger residents.
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Hawkins M, Sockalingam S, Bonato S, Rajaratnam T, Ravindran M, Gosse P, Sheehan KA. A rapid review of the pathoetiology, presentation, and management of delirium in adults with COVID-19. J Psychosom Res 2021; 141:110350. [PMID: 33401078 PMCID: PMC7762623 DOI: 10.1016/j.jpsychores.2020.110350] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Abstract
Background COVID-19 causes significant morbidity and mortality. Despite the high prevalence of delirium and delirium-related symptoms in COVID-19 patients, data and evidence-based recommendations on the pathophysiology and management of delirium are limited. Objective We conducted a rapid review of COVID-19-related delirium literature to provide a synthesis of literature on the prevalence, pathoetiology, and management of delirium in these patients. Methods Systematic searches of Medline, Embase, PsycInfo, LitCovid, WHO-COVID-19, and Web of Science electronic databases were conducted. Grey literature was also reviewed, including preprint servers, archives, and websites of relevant organizations. Search results were limited to the English language. We included literature focused on adults with COVID-19 and delirium. Papers were excluded if they did not mention signs or symptoms of delirium. Results 229 studies described prevalence, pathoetiology, and/or management of delirium in adults with COVID-19. Delirium was rarely assessed with validated tools. Delirium affected >50% of all patients with COVID-19 admitted to the ICU. The etiology of COVID-19 delirium is likely multifactorial, with some evidence of direct brain effect. Prevention remains the cornerstone of management in these patients. To date, there is no evidence to suggest specific pharmacological strategies. Discussion Delirium is common in COVID-19 and may manifest from both indirect and direct effects on the central nervous system. Further research is required to investigate contributing mechanisms. As there is limited empirical literature on delirium management in COVID-19, management with non-pharmacological measures and judicious use of pharmacotherapy is suggested.
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Affiliation(s)
- Michael Hawkins
- Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Sarah Bonato
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Thiyake Rajaratnam
- Centre for Addiction and Mental Health, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | | | - Paula Gosse
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kathleen Ann Sheehan
- Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
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46
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Lascarrou JB, Colin G, Le Thuaut A, Serck N, Ohana M, Sauneuf B, Geri G, Mesland JB, Ribeyre G, Hussenet C, Boureau AS, Gille T. Predictors of negative first SARS-CoV-2 RT-PCR despite final diagnosis of COVID-19 and association with outcome. Sci Rep 2021; 11:2388. [PMID: 33504923 PMCID: PMC7840684 DOI: 10.1038/s41598-021-82192-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
Reverse transcriptase-polymerase chain reaction (RT-PCR) testing is an important tool for diagnosing coronavirus disease 2019 (COVID-19). However, performance concerns have emerged recently, notably regarding sensitivity. We hypothesized that the clinical, biological, and radiological characteristics of patients with a false-negative first RT-PCR test and a final diagnosis of COVID-19 might differ from those of patients with a positive first RT-PCR test. We conducted a multicenter matched case–control study in COVID-19 patients. Patients with a negative first RT-PCR test were matched to patients with a positive first RT-PCR test on age, sex, and initial admission unit (ward or intensive care). We included 80 cases and 80 controls between March 30, and June 22, 2020. Neither mortality at hospital discharge nor hospital stay length differed between the two groups (P = 0.80 and P = 0.54, respectively). By multivariate analysis, two factors were independently associated with a lower risk of a first false-negative test, namely, headache (adjusted OR [aOR], 0.07; 95% confidence interval [95% CI], 0.01–0.49]; P = 0.007) and fatigue/malaise (aOR, 0.16; 95% CI, 0.03–0.81; P = 0.027); two other factors were independently associated with a higher risk of a first false-negative test, namely, platelets > 207·103 mm−3 (aOR, 3.81; 95% CI, 1.10–13.16]; P = 0.034) and C-reactive protein > 79.8 mg·L−1 (aOR, 4.00; 95% CI, 1.21–13.19; P = 0.023). Patients with suspected COVID-19 whose laboratory tests indicating marked inflammation were at higher risk of a first false-negative RT-PCR test. Strategies involving serial RT-PCR testing must be rigorously evaluated.
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Affiliation(s)
- Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. .,CRICS-TRIGGERSEP Network, Tours, France.
| | - Gwenhael Colin
- CRICS-TRIGGERSEP Network, Tours, France.,Médecine Intensive Réanimation, Centre Hospitalier Departemental, La Roche-sur-Yon, France
| | - Aurélie Le Thuaut
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 9, France
| | - Nicolas Serck
- Unité de Soins Intensifs, Clinique Saint Pierre Ottignies, Ottignies, Belgium
| | - Mickael Ohana
- Service de Radiologie, CHRU Strasbourg, Strasbourg, France
| | - Bertrand Sauneuf
- Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, BP208, 50102, Cherbourg-en-Cotentin, France
| | - Guillaume Geri
- Médecine Intensive Réanimation, CHU Ambroise Paré, Boulogne Billancourt, France
| | | | | | - Claire Hussenet
- Médecine Polyvalente, Nouvelles Cliniques Nantaises, Nantes, France
| | | | - Thomas Gille
- Pneumologie, University Hospital Center Avicenne, AP-HP, Bobigny, France.,Inserm UMR 1272 "Hypoxia and the Lung", Sorbonne Paris Nord University, Bobigny, France
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47
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Palich R, Wakim Y, Itani O, Paccoud O, Boussouar S, Lévy-Soussan M, Soulie C, Godefroy N, Bleibtreu A. Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients. Infect Dis Now 2021; 51:368-373. [PMID: 33495763 PMCID: PMC7816947 DOI: 10.1016/j.idnow.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
Objective To describe clinical, biological, radiological presentation and W4 status in COVID-19 elderly patients. Patients and methods All patients ≥ 70 years with confirmed SARS-CoV-2 infection and hospitalized in the Infectious Diseases department of the Pitié-Salpêtrière hospital, Paris, France, from March 1st to April 15th 2020 were included. The primary outcome was death four weeks after hospital admission. Data on demographics, clinical features, laboratory tests, CT-scan findings, therapeutic management and complications were collected. Results All in all, 100 patients were analyzed, including 49 patients ≥ 80 years. Seventy percent had ≥2 comorbidities. Respiratory features were often severe as 48% needed oxygen support upon admission. Twenty-eight out of 43 patients (65%) with a CT-scan had mild to severe parenchymal impairment, and 38/43 (88%) had bilateral impairment. Thirty-two patients presented respiratory distress requiring oxygen support ≥ 6 liters/minute. Twenty-four deaths occurred, including 21 during hospitalization in our unit, 2 among the 8 patients transferred to ICU, and one at home after discharge from hospital, leading to a global mortality rate of 24% at W4. Age, acute renal failure and respiratory distress were associated with mortality at W4. Conclusion A substantial proportion of elderly COVID-19 patients with several comorbidities and severe clinical features survived, a finding that could provide arguments against transferring the most fragile patients to ICU.
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Affiliation(s)
- R Palich
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France.
| | - Y Wakim
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - O Itani
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - O Paccoud
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - S Boussouar
- Sorbonne Université, LIB-Laboratoire d'imagerie biomédicale, Inserm, CNRS, ICAN Institute of CardioMetabolism and Nutrition, ACTION Study Group, Cardiothoracic Imaging Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - M Lévy-Soussan
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Palliative Care, 75013 Paris, France
| | - C Soulie
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, 75013 Paris, France
| | - N Godefroy
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - A Bleibtreu
- Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l'hôpital, 75013 Paris, France
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48
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Aliberti MJR, Covinsky KE, Garcez FB, Smith AK, Curiati PK, Lee SJ, Dias MB, Melo VJD, Rego-Júnior OFD, Richinho VDP, Jacob-Filho W, Avelino-Silva TJ. A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults. Age Ageing 2021; 50:32-39. [PMID: 33068099 PMCID: PMC7665299 DOI: 10.1093/ageing/afaa240] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability. OBJECTIVE This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients. DESIGN Cohort study. SETTING Large university hospital dedicated to providing COVID-19 care. PARTICIPANTS Participants included are 1,428 consecutive inpatients aged ≥50 years. METHODS Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission. RESULTS The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models. CONCLUSIONS Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.
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Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Pedro Kallas Curiati
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Murilo Bacchini Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Victor José Dornelas Melo
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Otávio Fortes do Rego-Júnior
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Valéria de Paula Richinho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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49
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Bertrand C, Laurent M, Lecarpentier E. Aide médicale urgente — établissement d’hébergement des personnes âgées dépendantes : retour d’expérience d’une organisation innovante pendant la crise Covid-19. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La crise sanitaire Covid-19 a obligé les Samu–Smur à adapter leurs organisations au jour le jour. La régulation a dû trouver des réponses spécifiques aux types d’appels, au plan quantitatif et qualitatif. En lien avec la médecine générale et les recommandations ministérielles, le Samu devait être le garant d’une juste orientation des patients vers les services hospitaliers. Le Samu 94 et la faculté de santé de Créteil ont créé une cellule dédiée aux établissements d’hébergement des personnes âgées dépendantes, accessible via une ligne spécialisée du Samu–centre 15, offrant 24 heures/24 l’accès à des compétences gériatriques et conseils divers, véritable lien ville–hôpital. Le retour d’expérience montre que cette cellule est une des facettes, dans le domaine de la gériatrie, de ce qu’est le concept de service d’accès aux soins (SAS) et qu’il ne faut pas attendre un rebond de crise pour en consolider les fondements.
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