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Curiati PK, Arruda MDS, Carpenter CR, Morinaga CV, Melo HMA, Avelino-Silva TJ, Aliberti MR. Predicting posthospitalization falls in Brazilian older adults: External validation of the Carpenter instrument. Acad Emerg Med 2024. [PMID: 38450932 DOI: 10.1111/acem.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES This study sought to explore and externally validate the Carpenter instrument's efficacy in predicting postdischarge fall risk among older adults admitted to the emergency department (ED) for reasons other than falls or related injuries. METHODS A prospective cohort study was conducted on 779 patients aged ≥ 65 years from a tertiary hospital in São Paulo, Brazil, who were monitored for up to 6 months post-ED hospitalization. The Carpenter instrument, which evaluates the four risk factors nonhealing foot sores, self-reported depression, inability to self-clip toenails, and prior falls, was utilized to assess fall risk. Follow-up by telephone occurred at 30, 90, and 180 days to identify falls and mortality. Fine-Gray models estimated the predictive power of Carpenter instrument for future falls, considering death as a competing event and sociodemographic factors, frail status, and clinical measures as confounders. RESULTS Among 779 patients, 68 (9%) experienced a fall within 180 days post-ED admission, and 88 (11%) died. The majority were male (54%), with a mean age of 79 years. Upon utilizing the Carpenter score, those with a higher fall risk (≥2 points) displayed more comorbidities, greater frailty, and increased clinical severity at baseline. Regression analyses showed that every additional point on the Carpenter score increased the hazard of falls by 73%. Two primary contributors to its predictive potential were identified: a history of falls in the preceding year and an inability to self-clip toenails. However, the instrument's discriminative accuracy was suboptimal, with an area under the curve of 0.62. CONCLUSIONS While the Carpenter instrument associated with a higher 6-month postadmission fall risk among older adults post-ED visit, its accuracy for individual patient decision making was limited. Given the significant impact of falls on health outcomes and health care costs, refining risk assessment tools remains essential. Future research should focus on enhancing these assessments and devising targeted proactive strategies.
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Affiliation(s)
- Pedro K Curiati
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
- Geriatric Center for Advanced Medicine, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Marcela Dos S Arruda
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
- Gerontology Post Graduate Program, Health Sciences Center, Pernambuco Federal University
| | | | - Christian V Morinaga
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
| | - Hugo M A Melo
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
- Gerontology Post Graduate Program, Health Sciences Center, Pernambuco Federal University
| | - Thiago J Avelino-Silva
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
- Geriatric Center for Advanced Medicine, Sírio-Libanês Hospital, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Marlon R Aliberti
- Geriatric Emergency Department Research Group (ProAGE), Sírio-Libanês Hospital, São Paulo, Brazil
- Geriatric Center for Advanced Medicine, Sírio-Libanês Hospital, São Paulo, Brazil
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Ritto AP, de Araujo AL, de Carvalho CRR, De Souza HP, Favaretto PMES, Saboya VRB, Garcia ML, Kulikowski LD, Kallás EG, Pereira AJR, Cobello Junior V, Silva KR, Abdalla ERF, Segurado AAC, Sabino EC, Ribeiro Junior U, Francisco RPV, Miethke-Morais A, Levin ASS, Sawamura MVY, Ferreira JC, Silva CA, Mauad T, Gouveia NDC, Letaif LSH, Bego MA, Battistella LR, Duarte AJDS, Seelaender MCL, Marchini J, Forlenza OV, Rocha VG, Mendes-Correa MC, Costa SF, Cerri GG, Bonfá ESDDO, Chammas R, de Barros Filho TEP, Busatto Filho G. Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic. Front Public Health 2024; 12:1369129. [PMID: 38476486 PMCID: PMC10927964 DOI: 10.3389/fpubh.2024.1369129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency. Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output. Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19. Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
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Affiliation(s)
- Ana Paula Ritto
- Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Heraldo Possolo De Souza
- Departamento de Emergências Médicas, Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Manga e Silva Favaretto
- Diretoria Executiva dos Laboratórios de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vivian Renata Boldrim Saboya
- Diretoria Executiva dos Laboratórios de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Michelle Louvaes Garcia
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Esper Georges Kallás
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Vilson Cobello Junior
- Núcleo Especializado em Tecnologia da Informação, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Katia Regina Silva
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eidi Raquel Franco Abdalla
- Divisão de Biblioteca e Documentação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aluisio Augusto Cotrim Segurado
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Departamento de Gastroenterologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Miethke-Morais
- Diretoria Clínica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Sara Shafferman Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcio Valente Yamada Sawamura
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Carvalho Ferreira
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis Artur Silva
- Instituto da Criança e do Adolescente, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nelson da Cruz Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leila Suemi Harima Letaif
- Diretoria Clínica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marco Antonio Bego
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Linamara Rizzo Battistella
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Divisão de Laboratório Central, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Julio Marchini
- Departamento de Emergências Médicas, Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Orestes Vicente Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Geraldo Rocha
- Departamento de Clínica Médica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cassia Mendes-Correa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giovanni Guido Cerri
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roger Chammas
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Geraldo Busatto Filho
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Bicalho MAC, Aliberti MJR, Delfino-Pereira P, Chagas VS, Rosa PMDS, Pires MC, Ramos LEF, Bezerra AFB, de Castro Feres AB, Dos Reis Gomes AG, Bhering AR, Pessoa BP, Silva CTCAD, Cimini CCR, Suemoto CK, Dias CAC, Carazai DDR, Ponce D, Rios DRA, Manenti E, Anschau F, Batista JDL, Alvarenga JCD, Viguini JA, Zanellato JM, Rugolo JM, Ruschel KB, do Nascimento L, Menezes LSM, Oliveira LMCD, Castro LCD, Nasi LA, Carneiro M, Ferreira MAP, Godoy MFD, Guimarães-Júnior MH, Oliveira NRD, Ziegelmann PK, Porto PF, Mendes PM, Paraíso PG, Reis PPD, Francisco SC, Araújo SF, Avelino-Silva TJ, Marcolino MS. Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study. BMC Geriatr 2024; 24:25. [PMID: 38182982 PMCID: PMC10770897 DOI: 10.1186/s12877-023-04494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
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Affiliation(s)
- Maria Aparecida Camargos Bicalho
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil.
- Cologne University, Albertus-Magnus-Platz, Cologne, 50923, Allemagne.
| | - Márlon Juliano Romero Aliberti
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Polianna Delfino-Pereira
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
| | - Victor Schulthais Chagas
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Medical School, Universidade Federal de Viçosa, Av. Peter Henry Rolfs, S/N, Viçosa, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
| | - Patryk Marques da Silva Rosa
- Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | | | | | | | | | - Bruno Porto Pessoa
- Hospital Júlia Kubitschek, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, R. Do Cruzeiro, 01, Teófilo Otoni, Brazil
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | - Claudia Kimie Suemoto
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Daniela Dos Reis Carazai
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu, Brazil
| | | | - Euler Manenti
- Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Universidade Federal da Fronteira Sul, Rod. SC-459, Km 02, Fronteira Sul, Chapecó, Brazil
- Hospital Regional do Oeste, Hospital Regional do Oeste, Florianópolis street, Brazil
| | | | - Julia Avancini Viguini
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Juliana Machado Rugolo
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Hospital Universitário Canoas, Av. Farroupilha, 8001, Canoas, Brazil
| | | | - Luanna Silva Monteiro Menezes
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
- Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil
| | | | | | - Luiz Antônio Nasi
- Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil
| | | | | | | | | | | | - Paula Fonseca Porto
- Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil
| | | | - Pedro Gibson Paraíso
- Orizonti - Instituto Oncomed de Saúde e Longevidade, Av. José Do Patrocínio Pontes, 1355, Belo Horizonte, Brazil
| | | | | | | | - Thiago Junqueira Avelino-Silva
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Global Brain Health Institute, University of California, Av, Raja Gabaglia, San Francisco, Estoril, USA
| | - Milena Soriano Marcolino
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Scarlata S, Zotti S, Finamore P, Osadnik CR, Scichilone N, Antonelli Incalzi R, Claudio P, Cesari M. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns. Aging Clin Exp Res 2023; 35:2573-2581. [PMID: 37644258 DOI: 10.1007/s40520-023-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. AIMS To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. METHODS This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. RESULTS Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. CONCLUSION Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Sonia Zotti
- Department of Medicine and Surgery, Internship Program in Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Panaiotis Finamore
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Moorooduc Hwy, Frankston, Melbourne, VIC, 3199, Australia
- Monash Lung and Sleep Department, Monash Health, 246 Clayton Road, CLAYTON, Melbourne, VIC, 3168, Australia
| | - Nicola Scichilone
- PROMISE Department, University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Pedone Claudio
- Operative Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milano, Italy
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Deng Y, Zhang K, Zhu J, Hu X, Liao R. Healthy aging, early screening, and interventions for frailty in the elderly. Biosci Trends 2023; 17:252-261. [PMID: 37612123 DOI: 10.5582/bst.2023.01204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
With the intensification of population aging worldwide, the health problems of the elderly have become a particular concern. Functional disability is a prominent problem in the aging of this population, resulting in the decreased quality of life of senile people. Risk factors for functional disability in the elderly include geriatric syndromes and the associated diseases such as frailty. The influence of frailty on the health of the elderly has been a hot topic in recent years. As a dynamic and reversible geriatric syndrome, it has become one of the important public health problems emerging around the world. Frailty lies between self-reliance and the need for care and is reversible. Reasonable preventive interventions can restore the elderly to an independent life. If no interventions are implemented, the elderly will face a dilemma. There is no gold standard for frailty screening around the world. In order to alleviate frailty in the elderly, many countries have conducted early screening for frailty, mainly focusing on nutrition, physical activity, and social participation, in order to detect and prevent frailty earlier and to reduce the incidence of frailty. This topic provides an overview of the current status of frailty, early screening for frailty, and the interventions for frailty in most countries of the world.
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Affiliation(s)
- Yi Deng
- Department of Geriatric Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keming Zhang
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Jiali Zhu
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing, China
| | - Xiaofeng Hu
- Department of Hepatobiliary Surgery, First Hospital Affiliated with Chongqing Medical University, Chongqing, China
| | - Rui Liao
- Department of Hepatobiliary Surgery, First Hospital Affiliated with Chongqing Medical University, Chongqing, China
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Chen JT, Mehrizi R, Aasman B, Gong MN, Mirhaji P. Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort. BMJ Health Care Inform 2023; 30:e100782. [PMID: 37709302 PMCID: PMC10503386 DOI: 10.1136/bmjhci-2023-100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To identify the risk of acute respiratory distress syndrome (ARDS) and in-hospital mortality using long short-term memory (LSTM) framework in a mechanically ventilated (MV) non-COVID-19 cohort and a COVID-19 cohort. METHODS We included MV ICU patients between 2017 and 2018 and reviewed patient records for ARDS and death. Using active learning, we enriched this cohort with MV patients from 2016 to 2019 (MV non-COVID-19, n=3905). We collected a second validation cohort of hospitalised patients with COVID-19 in 2020 (COVID+, n=5672). We trained an LSTM model using 132 structured features on the MV non-COVID-19 training cohort and validated on the MV non-COVID-19 validation and COVID-19 cohorts. RESULTS Applying LSTM (model score 0.9) on the MV non-COVID-19 validation cohort had a sensitivity of 86% and specificity of 57%. The model identified the risk of ARDS 10 hours before ARDS and 9.4 days before death. The sensitivity (70%) and specificity (84%) of the model on the COVID-19 cohort are lower than MV non-COVID-19 cohort. For the COVID-19 + cohort and MV COVID-19 + patients, the model identified the risk of in-hospital mortality 2.4 days and 1.54 days before death, respectively. DISCUSSION Our LSTM algorithm accurately and timely identified the risk of ARDS or death in MV non-COVID-19 and COVID+ patients. By alerting the risk of ARDS or death, we can improve the implementation of evidence-based ARDS management and facilitate goals-of-care discussions in high-risk patients. CONCLUSION Using the LSTM algorithm in hospitalised patients identifies the risk of ARDS or death.
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Affiliation(s)
- Jen-Ting Chen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, UCSF, San Francisco, California, USA
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rahil Mehrizi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Boudewijn Aasman
- Center for Health Data Innovations, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michelle Ng Gong
- Department of Medicine, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Parsa Mirhaji
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
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7
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Gonçalves NG, Aliberti MJR, Bertola L, Avelino-Silva T, Dias MB, Apolinario D, Busatto G, Forlenza O, Nitrini R, Brucki SMD, Brunoni AR, Vidal KSM, Jacob-Filho W, Suemoto CK. Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization. Alzheimers Dement 2023; 19:3771-3782. [PMID: 36861807 DOI: 10.1002/alz.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. METHODS A total of 1105 adults (mean age ± SD 64.9 ± 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. RESULTS Three groups of cognitive trajectories were observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (β = -0.013, 95% CI = -0.023;-0.003), female sex (β = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (β = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (β = -0.191, 95% CI = -0.264;-0.119), higher platelet count (β = -0.101, 95% CI = -0.185;-0.018), and delirium (β = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. DISCUSSION Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. HIGHLIGHTS Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
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Affiliation(s)
- Natalia Gomes Gonçalves
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Laiss Bertola
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago Avelino-Silva
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Murilo Bacchini Dias
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Geraldo Busatto
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes Forlenza
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Andre Russowsky Brunoni
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
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8
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Aliberti MJR, Levites MR, Berardo FAN. The effectiveness of postacute intensive rehabilitation on severe COVID-19 patients: A case-control study. Health Sci Rep 2023; 6:e1506. [PMID: 37599653 PMCID: PMC10439337 DOI: 10.1002/hsr2.1506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Márlon J. R. Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66)Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao PauloSao PauloBrazil
- Research InstituteHospital Sirio‐LibanesSao PauloBrazil
| | - Marcelo R. Levites
- Department of Internal MedicinePost‐Acute Care Premium CareSao PauloBrazil
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9
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Levy Y, Derazne E, Shilovsky A, Kagansky D, Derkath A, Chepelev V, Mazurez E, Stambler I, Kagansky N. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio, are they markers of COVID-19 severity or old age and frailty? A comparison of two distinct cohorts. Front Med (Lausanne) 2023; 10:1222692. [PMID: 37575993 PMCID: PMC10413384 DOI: 10.3389/fmed.2023.1222692] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple markers of systemic inflammatory responses. It has been previously suggested that they can predict COVID-19 severity. Age and frailty may also influence their values. This study aimed to evaluate the impact of COVID-19 severity versus age and frailty on NLR and PLR values. This was a retrospective, observational two cohorts' comparative study. The first cohort is comprised of patents positive for SARS-CoV-2, with mild or asymptomatic disease, admitted to designated COVID-19 departments in a large geriatric medical center (GMC). The second included patients with COVID-19 admitted to designated COVID-19 departments in a large general hospital for symptomatic disease from March 2020 to March 2021. We compared baseline characteristics including comorbidities and chronic medications, disease symptoms, laboratory tests and compared the NLR and PLR between the two groups. The 177 patients admitted to the COVID-designated department in the GMC were over three decades older than the 289 COVID-19 patients admitted to the general hospital care (HC). They had substantially more comorbidities and chronic medications. All common disease symptoms were significantly more common in the HC group. Almost two thirds of the GMC patients remained asymptomatic compared to 2.1% in the HC group. Inflammatory markers, such as CRP and LDH, were significantly higher in the HC group. The NLR and PLR were both significantly higher in the GMC cohort comprised of older frailer patients with milder disease. NLR and PLR seem to be affected more by age and frailty than COVID-19 severity.
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Affiliation(s)
- Yochai Levy
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler School of Medicine, Tel Aviv, Israel
| | | | - Alex Shilovsky
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | | | - Alex Derkath
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | - Victor Chepelev
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | - Evelina Mazurez
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
| | | | - Nadya Kagansky
- Sackler School of Medicine, Tel Aviv, Israel
- Shmuel Harofe Geriatric Medical Center, Be'er Ya'akov, Israel
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10
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Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L, de Gopegui Miguelena PR, Heyland DK, Hewitt D, Hope AA, Langlais E, Le Maguet P, Montgomery CL, Papageorgiou D, Seguin P, Geense WW, Silva-Obregón JA, Wolff G, Polzin A, Dannenberg L, Kelm M, Flaatten H, Beil M, Franz M, Sviri S, Leaver S, Guidet B, Boumendil A, Jung C. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care 2023; 13:37. [PMID: 37133796 PMCID: PMC10155148 DOI: 10.1186/s13613-023-01132-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). METHODS A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). RESULTS 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25-1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26-1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4-5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1-3. CONCLUSIONS Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its "continuum" better and predict ICU outcome more accurately. TRIAL REGISTRATION Open Science Framework (OSF: https://osf.io/8buwk/ ).
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Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110, Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jai N Darvall
- Intensive Care Unit and Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden
| | | | - Daren K Heyland
- Clinical Evaluation Research Unit, and Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - David Hewitt
- Glasgow Royal Infirmary Intensive Care Unit, Glasgow, Scotland
| | - Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Emilie Langlais
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Pascale Le Maguet
- Département d'Anesthésie Réanimation, CHU Rennes, Rennes, France
- Service d'Anesthésie, CH Quimper, Quimper, France
| | - Carmel L Montgomery
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 3-171, Edmonton, AB, T6G 1C9, Canada
| | - Dimitrios Papageorgiou
- Faculty of Health and Caring Sciences Department of Nursing, University of West Attica (UWA) Athens, Egaleo, Greece
| | - Philippe Seguin
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Wytske W Geense
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alberto Silva-Obregón
- Department of Intensive Care Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Dannenberg
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), University Hospital of Düsseldorf, Germany, Düsseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Dept. of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07737, Jena, Germany
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bertrand Guidet
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Ariane Boumendil
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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11
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Rockstrom M, Balaban E, Fakhri S, Peterson RA, Jin Y, Jolley SE, Erlandson KM, Hippensteel JA. Predictors of adverse outcomes in aged patients critically ill with COVID-19: a retrospective study. J Investig Med 2023; 71:315-320. [PMID: 36655809 PMCID: PMC9902787 DOI: 10.1177/10815589221150644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
Older patients represent an inordinate proportion of intensive care unit (ICU) admissions and ICU mortality associated with coronavirus disease 2019 (COVID-19). In this retrospective cohort study, we examine 198 patients, aged 18 years or older, admitted to the ICU from March to June 2020. We aim to understand the relationships between age, number of comorbidities, and independent living prior to admission on outcomes of mortality, length of stay, renal failure, respiratory failure, and shock. In this cohort, we find that overall mortality was associated with respiratory failure severity (for every decrease of P:F by 50, odds ratio (OR) 2.98 (1.65-6.08)), acute renal failure (OR 4.61 (1.2-19.7)), and age 65 or greater (OR: 3.7 (1.86-7.36)). Surprisingly, increasing age was associated with less severe respiratory failure (R = 0.22, p < 0.01). When adjusting for pre-existing chronic kidney disease, age was not associated with development of acute kidney injury (OR: 1.01 (0.99-1.03)). While chronologic age is associated with mortality, it is not associated independently with severe end organ damage. This is consistent with growing evidence suggesting that a complex interplay between multimorbidity, immunosenescence, and physiologic age is primarily responsible for the vulnerability to COVID-19.
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Affiliation(s)
- Matthew Rockstrom
- Division of General Internal Medicine,
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,
USA
| | - Eric Balaban
- Division of Hospital Medicine,
Department of Medicine, University of Pittsburg Medical Center, Pittsburgh, PA,
USA
| | - Shoaib Fakhri
- Division of Pulmonary, Allergy, and
Critical Care Medicine, Department of Medicine, University of Pittsburg Medical
Center, Pittsburgh, PA, USA
| | - Ryan A Peterson
- Department of Biostatistics &
Informatics, Colorado School of Public Health, University of Colorado Anschutz
Medical Campus, Aurora, CO, USA
| | - Ying Jin
- Department of Biostatistics &
Informatics, Colorado School of Public Health, University of Colorado Anschutz
Medical Campus, Aurora, CO, USA
| | - Sarah E Jolley
- Division of Pulmonary Sciences and
Critical Care Medicine, Department of Medicine, University of Colorado Anschutz
Medical Campus, Aurora, CO, USA
| | - Kristine M Erlandson
- Division of Infectious Disease,
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,
USA
| | - Joseph A Hippensteel
- Division of Pulmonary Sciences and
Critical Care Medicine, Department of Medicine, University of Colorado Anschutz
Medical Campus, Aurora, CO, USA
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12
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Szlejf C, Suemoto CK, Goulart AC, Santos IDS, Bacchi PS, Fatori D, Razza LB, Viana MC, Lotufo PA, Benseñor IM, Brunoni AR. A pandemic toll in frail older adults: Higher odds of incident and persistent common mental disorders in the ELSA-Brasil COVID-19 mental health cohort. J Affect Disord 2023; 325:392-398. [PMID: 36627055 PMCID: PMC9824948 DOI: 10.1016/j.jad.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We aimed to investigate the association of frailty with persistent and incident common mental disorders (CMD) in older adults during the pandemic. METHODS We included 706 older adults who participated in the onsite wave of the ELSA-Brasil study (2017-2019) and the online COVID-19 assessment (May-July 2020). CMD were assessed in both waves by the Clinical Interview Schedule-Revised. Frailty was defined according to the physical phenotype and Frailty Index in the 2017-2019 wave. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics. RESULTS Frailty according to both definitions were associated with persistent CMD (Frailty Index: OR = 8.61, 95 % CI = 4.08-18.18; physical phenotype: OR = OR = 23.67, 95 % CI = 7.08-79.15), and incident CMD (Frailty Index: OR = 2.79, 95 % CI = 1.15-6.78; physical phenotype OR = 4.37, 95 % CI = 1.31-14.58). The exclusion of exhaustion (that overlaps with psychiatric symptoms) from the frailty constructs did not change the association between frailty and persistent CMD, although the associations with indent CMD were no longer significant. LIMITATIONS Fluctuations in CMD status were not captured between both assessments. CONCLUSION Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the pandemic first wave. Identifying individuals at higher risk of mental burden can help prioritize resources allocation and management.
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Affiliation(s)
- Claudia Szlejf
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| | - Claudia Kimie Suemoto
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Division of Geriatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Itamar de Souza Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | | | - Daniel Fatori
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium
| | - Maria Carmen Viana
- Centro de Estudos e Pesquisa em Epidemiologia Psiquiátrica, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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13
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Matsumoto C, Shibata S, Kishi T, Morimoto S, Mogi M, Yamamoto K, Kobayashi K, Tanaka M, Asayama K, Yamamoto E, Nakagami H, Hoshide S, Mukoyama M, Kario K, Node K, Rakugi H. Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19. Hypertens Res 2023; 46:601-619. [PMID: 36575228 PMCID: PMC9793823 DOI: 10.1038/s41440-022-01145-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
The coronavirus disease 2019 (COVID-19) affects infected patients even after the acute phase and impairs their health and quality of life by causing a wide variety of symptoms, referred to as long COVID. Although the evidence is still insufficient, hypertension is suspected to be a potential risk factor for long COVID, and the occurrence of cardiovascular diseases seems to be a key facet of multiple conditions observed in long COVID. Nonetheless, there are few reports that comprehensively review the impacts of long COVID on hypertension and related disorders. As a sequel to our previous report in 2020 which reviewed the association of COVID-19 and hypertension, we summarize the possible influences of long COVID on hypertension-related organs, including the cardiovascular system, kidney, and endocrine system, as well as the pathophysiological mechanisms associated with the disorders in this review. Given that the clinical course of COVID-19 is highly affected by age and sex, we also review the impacts of these factors on long COVID. Lastly, we discuss areas of uncertainty and future directions, which may lead to better understanding and improved prognosis of clinical problems associated with COVID-19.
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Affiliation(s)
- Chisa Matsumoto
- Department of Cardiology, Preventive medicine, Tokyo Medical University, Tokyo, Japan.
| | - Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Takuya Kishi
- Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Japan
| | - Satoshi Morimoto
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaki Mogi
- Department of Pharmacology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuo Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Kobayashi Internal Medicine Clinic, Sagamihara, Japan
| | - Masami Tanaka
- Department of Internal Medicine, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Hironori Nakagami
- Department of Health Development and Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.,Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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14
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de Paiva BBM, Pereira PD, de Andrade CMV, Gomes VMR, Souza-Silva MVR, Martins KPMP, Sales TLS, de Carvalho RLR, Pires MC, Ramos LEF, Silva RT, de Freitas Martins Vieira A, Nunes AGS, de Oliveira Jorge A, de Oliveira Maurílio A, Scotton ALBA, da Silva CTCA, Cimini CCR, Ponce D, Pereira EC, Manenti ERF, Rodrigues FD, Anschau F, Botoni FA, Bartolazzi F, Grizende GMS, Noal HC, Duani H, Gomes IM, Costa JHSM, di Sabatino Santos Guimarães J, Tupinambás JT, Rugolo JM, Batista JDL, de Alvarenga JC, Chatkin JM, Ruschel KB, Zandoná LB, Pinheiro LS, Menezes LSM, de Oliveira LMC, Kopittke L, Assis LA, Marques LM, Raposo MC, Floriani MA, Bicalho MAC, Nogueira MCA, de Oliveira NR, Ziegelmann PK, Paraiso PG, de Lima Martelli PJ, Senger R, Menezes RM, Francisco SC, Araújo SF, Kurtz T, Fereguetti TO, de Oliveira TC, Ribeiro YCNMB, Ramires YC, Lima MCPB, Carneiro M, Bezerra AFB, Schwarzbold AV, de Moura Costa AS, Farace BL, Silveira DV, de Almeida Cenci EP, Lucas FB, Aranha FG, Bastos GAN, Vietta GG, Nascimento GF, Vianna HR, Guimarães HC, de Morais JDP, Moreira LB, de Oliveira LS, de Deus Sousa L, de Souza Viana L, de Souza Cabral MA, Ferreira MAP, de Godoy MF, de Figueiredo MP, Guimarães-Junior MH, de Paula de Sordi MA, da Cunha Severino Sampaio N, Assaf PL, Lutkmeier R, Valacio RA, Finger RG, de Freitas R, Guimarães SMM, Oliveira TF, Diniz THO, Gonçalves MA, Marcolino MS. Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset. Sci Rep 2023; 13:3463. [PMID: 36859446 PMCID: PMC9975879 DOI: 10.1038/s41598-023-28579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.
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Affiliation(s)
- Bruno Barbosa Miranda de Paiva
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Polianna Delfino Pereira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil ,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil
| | - Claudio Moisés Valiense de Andrade
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Virginia Mara Reis Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maira Viana Rego Souza-Silva
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Karina Paula Medeiros Prado Martins
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Thaís Lorenna Souza Sales
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | | | - Magda Carvalho Pires
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Rafael Tavares Silva
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | - Daniela Ponce
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | | | - Fernanda d’Athayde Rodrigues
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Frederico Bartolazzi
- Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | - Genna Maira Santos Grizende
- grid.477816.b0000 0004 4692 337XHospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales, 1111, Belo Horizonte, Brazil
| | - Helena Carolina Noal
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | - Helena Duani
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Isabela Moraes Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | | | | | | | - Juliana Machado Rugolo
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | - Joanna d’Arc Lyra Batista
- grid.440565.60000 0004 0491 0431Universidade Federal da Fronteira Sul, Av. Fernando Machado, 108E, Chapecó, Brazil
| | | | - José Miguel Chatkin
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | - Karen Brasil Ruschel
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | | | | | - Luanna Silva Monteiro Menezes
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil ,Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil
| | | | - Luciane Kopittke
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Luisa Argolo Assis
- grid.412520.00000 0001 2155 6671Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500, Belo Horizonte, Brazil
| | - Luiza Margoto Marques
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Brazil
| | - Magda Cesar Raposo
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil ,Moinhos Research Institute, 910 Ramiro Barcelos Street, 5 floor, Porto Alegre, Brazil
| | - Maria Aparecida Camargos Bicalho
- grid.452464.50000 0000 9270 1314Fundação Hospitalar do Estado de Minas Gerais–FHEMIG, Cidade Administrativa de Minas Gerais, Edifício Gerais, 13rd floor, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil
| | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | - Roberta Senger
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | | | | | - Tatiana Kurtz
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Tatiani Oliveira Fereguetti
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Alexandre Vargas Schwarzbold
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | - Barbara Lopes Farace
- grid.490178.3Hospital Risoleta Tolentino Neves, R. das Gabirobas, 01, Belo Horizonte, Brazil
| | | | | | | | | | - Gisele Alsina Nader Bastos
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | | | | | | | | | | | - Leila Beltrami Moreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | | | - Máderson Alvares de Souza Cabral
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maria Angélica Pires Ferreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Mariana Frizzo de Godoy
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | | | | | - Mônica Aparecida de Paula de Sordi
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil
| | - Raquel Lutkmeier
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Rufino de Freitas
- Hospital São João de Deus, R. do Cobre, 800, São João de Deus, Brazil
| | | | | | | | - Marcos André Gonçalves
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil. .,Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil. .,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 room 107. Santa Efigênia, Belo Horizonte, MG, CEP 30130-100, Brazil.
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15
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Dias MB, Medeiros APV, de Melo SS, Fonseca CS, Jacob-Filho W, Avelino-Silva TJ, Aliberti MJR. The long and winding road of COVID-19 in survivors of hospitalisation: Symptoms trajectory and predictors of long COVID. J Intern Med 2023; 293:264-268. [PMID: 36316955 PMCID: PMC9878261 DOI: 10.1111/joim.13583] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Murilo B Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula V Medeiros
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sarah S de Melo
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cecilia S Fonseca
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 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, 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, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Márlon J R Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
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16
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Abstract
Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.
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17
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Taniguchi LU, Aliberti MJR, Dias MB, Jacob-Filho W, Avelino-Silva TJ. Calculating Route: Functional Trajectories and Long-Term Outcomes in Survivors of Severe COVID-19. J Nutr Health Aging 2023; 27:1168-1173. [PMID: 38151867 DOI: 10.1007/s12603-023-2036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES We investigated functional trajectories after severe COVID-19 and estimated their associations with adverse outcomes (falls, rehospitalizations, institutionalization, or death), cognition and post COVID-19 condition within 1-year of hospital discharge. DESIGN Prospective cohort study. SETTING A large academic medical center in Sao Paulo, Brazil. PARTICIPANTS Survivors of COVID-19 admissions to an intensive care unit. INTERVENTIONS None. MEASUREMENTS We evaluated participants' disability status before hospital admission and three, six, nine, and twelve months after discharge using 15 activities of daily living. During follow-up, cognition and post COVID-19 condition (defined as persistent symptoms with duration ≥2 months) were assessed. A latent class growth analysis was performed to investigate functional trajectories after discharge. RESULTS We included 422 participants (median age 63 years, 13.5% were frail before COVID-19). Four distinct functional trajectories could be identified: "minimal disability trajectory" (37.4% of participants), "mild disability trajectory" (37.9%), "moderate disability trajectory" (16.8%), and "severe disability trajectory" (7.8%). Compared with minimal disability trajectory, the odds ratios (95% confidence interval) for 1-year adverse outcomes were 2.28 (1.38-3.76) for minor disability trajectory; 4.21 (2.10-8.42) for moderate disability trajectory; and 4.16 (1.51-11.46) for severe disability trajectory, even after adjustments. The occurrence of post COVID-19 condition was 67.5% and associated with functional trajectories (p=0.004). Cognition was also associated with functional trajectories. CONCLUSION Severe COVID-19 survivors can experience diverse functional trajectories, with those presenting higher levels of disability at increased risk for long-term adverse outcomes. Further investigations are essential to confirm our findings and assess the effectiveness of rehabilitation interventions, aiming to improve health outcomes in those who survived severe COVID-19 and other causes of sepsis.
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Affiliation(s)
- L U Taniguchi
- Leandro Utino Taniguchi, Emergency Medicine Discipline, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, Postal Code: 05403-000, São Paulo, Brazil, e-mail: , telephone: 55-11-2661-6336, fax: 55-11-2662-6336
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18
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Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2023; 39:1-12. [PMID: 36322713 PMCID: PMC9889016 DOI: 10.1089/aid.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Darren J. Baker
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - George A. Kuchel
- UConn Center on Aging, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kathryn E. Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Bruce Brew
- Department of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
- Department of Neurology, Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Department of Neurology, University of New South Wales Sydney, Sydney, Australia
- University of Notre Dame Australia, Sydney, Australia
| | - Lucette A. Cysique
- Faculty of Science, Department of Psychology, School of Psychology, University of New South Wales Sydney, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Neuroscience Unit, St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Chelsie Wallen
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joseph B. Margolick
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Divisions of Infectious Diseases, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
- Divisions of Geriatric Medicine, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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19
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Resendes NM, Chada A, Torres-Morales A, Fernandez M, Diaz-Quiñones A, Gomez C, Oomrigar S, Burton L, Ruiz JG. Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection. J Nutr Health Aging 2023; 27:89-95. [PMID: 36806863 PMCID: PMC9893965 DOI: 10.1007/s12603-023-1886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Determine the association of higher FI-LAB scores, derived from common laboratory values and vital signs, with hospital and post-hospital outcomes in Veterans hospitalized with COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, cohort study of 7 Veterans Health Administration (VHA) medical centers in Florida and Puerto Rico. Patients aged 18 years and older hospitalized with COVID-19 and followed for up to 1 year post discharge or until death. Clinical Frailty Measure: FI-LAB. MAIN OUTCOMES AND MEASURES Hospital and post-hospital outcomes. RESULTS Of the 671 eligible patients, 615 (91.5%) patients were included (mean [SD] age, 66.1 [14.8] years; 577 men [93.8%]; median stay, 8 days [IQR:3-15]. There were sixty-one in-hospital deaths. Veterans in the moderate and high FI-LAB groups had a higher proportion of inpatient mortality (13.3% and 20.6%, respectively) than the low group (4.1%), p <0.001. Moderate and high FI-LAB scores were associated with greater inpatient mortality when compared to the low group, OR:3.22 (95%CI:1.59-6.54), p=.001 and 6.05 (95%CI:2.48-14.74), p<0.001, respectively. Compared with low FI-LAB scores, moderate and high scores were also associated with prolonged length of stay, intensive care unit (ICU) admission, and transfer. CONCLUSIONS AND RELEVANCE In this study of patients admitted to 7 VHA Hospitals during the first surge of the pandemic, higher FI-LAB scores were associated with higher in-hospital mortality and other in-hospital outcomes; FI-LAB can serve as a validated, rapid, feasible, and objective frailty tool in hospitalized adults with COVID-19 that can aid clinical care.
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Affiliation(s)
- N M Resendes
- Natasha Melo Resendes, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), GRECC (11GRC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, Florida 33125, USA, Telephone: (305) 575-3388 / Fax: (305) 575-3365, E-mail: , ORCID: 0000-0003-2867-7227
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20
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Zhang L, Jiang L, Tian T, Li W, Pan Y, Wang Y. Efficacy and Safety of COVID-19 Vaccination in Older Adults: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 11:vaccines11010033. [PMID: 36679878 PMCID: PMC9862835 DOI: 10.3390/vaccines11010033] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: To analyze the differences in efficacy and safety of different types of novel coronavirus pneumonia (COVID-19) vaccines in different age groups (young adults and elderly). Methods: Randomized controlled trials (RCTs) on COVID-19 vaccine in PubMed, Embase, Web of Science, and Cochrane library were searched by computer, and eight eligible studies were analyzed. Meta-analysis was performed using Stata 16.0 and RevMan5.4 software. Results: The mean geometric titer (GMT) of the virus in the elderly was significantly higher than that in the placebo group (SMD = 0.91, 95% CI (0.68, 1.15), p < 0.01), presenting no obvious difference compared with the young adults (SMD = 0.19, 95% CI (0.38, 0.01), p = 0.06). Meanwhile, the effect of multiple vaccinations was better than that of single vaccination (SMD = 0.83, 95% CI (0.33, 1.34), p < 0.01). However, the number of adverse events (AEs) in the elderly was lower than that in the young adults (OR = 0.35, 95% CI (0.29, 0.42), p < 0.01). Conclusions: The immunization effect of COVID-19 vaccine in the elderly is obvious, especially after multiple vaccinations, and the incidence of AEs in the elderly is low, which proves that the vaccination of the elderly is safe and effective.
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Affiliation(s)
- Lei Zhang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lihong Jiang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin 150086, China
| | - Wenjing Li
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yonghui Pan
- Fourth Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Correspondence: (Y.P.); (Y.W.)
| | - Yongchen Wang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
- Correspondence: (Y.P.); (Y.W.)
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21
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Lee YK, Motwani Y, Brook J, Martin E, Seligman B, Schaenman J. Predictors of COVID-19 outcomes: Interplay of frailty, comorbidity, and age in COVID-19 prognosis. Medicine (Baltimore) 2022; 101:e32343. [PMID: 36595791 PMCID: PMC9794263 DOI: 10.1097/md.0000000000032343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prior research has identified frailty, comorbidity, and age as predictors of outcomes for patients with coronavirus disease 2019 (COVID-19), including mortality. However, it remains unclear how these factors play different roles in COVID-19 prognosis. This study focused on correlations between frailty, comorbidity and age, and their correlations to discharge outcome and length-of-stay in hospitalized patients with COVID-19. Clinical data was collected from 56 patients who were ≥50 years old and admitted from March 2020 to June 2020 primarily for COVID-19. Frailty Risk Score (FRS) and the Charlson Comorbidity Index (CCI) were used for assessment of frailty and comorbidity burden, respectively. Age had significant positive correlation with FRS and CCI (P < .001, P < .001, respectively). There was also significant positive correlation between FRS and CCI (P < .001). For mortality, patients who died during their hospitalization had significantly higher FRS and CCI (P = .01 and P < .001, respectively) but were not significantly older than patients who did not. FRS, CCI, and age were all significantly associated when looking at overall adverse discharge outcome (transfer to other facility or death) (P < .001, P = .005, and P = .009, respectively). However, none of the 3 variables were significantly correlated with length-of-stay. Multivariate analysis showed FRS (P = .007) but not patient age (P = .967) was significantly associated with death. We find that frailty is associated with adverse outcomes from COVID-19 and supplants age in multivariable analysis. Frailty should be part of risk assessment of older adults with COVID-19.
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Affiliation(s)
- Yoon Kyung Lee
- UCLA David Geffen School of Medicine, Los Angeles, CA
- * Correspondence: Yoon Kyung Lee, UCLA David Geffen School of Medicine, Los Angeles, CA 90024 (e-mail: )
| | - Yash Motwani
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Jenny Brook
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Emily Martin
- UCLA Division of Infectious Diseases, Los Angeles, CA
| | - Benjamin Seligman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- West LA VA Geriatric Medicine, Los Angeles, CA
| | - Joanna Schaenman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- UCLA Division of Infectious Diseases, Los Angeles, CA
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22
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Mavragani A, Hardy F, Tucker K, Hopper A, Marchã MJM, Navaratnam AV, Briggs TWR, Yates J, Day J, Wheeler A, Eve-Jones S, Gray WK. Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data. Interact J Med Res 2022; 11:e41520. [PMID: 36423306 PMCID: PMC9746678 DOI: 10.2196/41520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. OBJECTIVE We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. METHODS This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. RESULTS In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. CONCLUSIONS The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19.
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Affiliation(s)
| | - Flavien Hardy
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Katie Tucker
- Innovation and Intelligent Automation Unit, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Adrian Hopper
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Maria J M Marchã
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing High Performance Computing Facility, University College London, London, United Kingdom
| | - Annakan V Navaratnam
- University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Tim W R Briggs
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Royal National Orthopaedic Hospital National Health Service Trust, London, United Kingdom
| | - Jeremy Yates
- Department of Computer Science, University College London, London, United Kingdom
| | - Jamie Day
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Andrew Wheeler
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Sue Eve-Jones
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - William K Gray
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
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23
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Hu FY, Streiter S, O'Mara L, Sison SM, Theou O, Bernacki R, Orkaby A. Frailty and Survival After In-Hospital Cardiopulmonary Resuscitation. J Gen Intern Med 2022; 37:3554-3561. [PMID: 34981346 PMCID: PMC9585129 DOI: 10.1007/s11606-021-07199-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Older adults face high mortality following resuscitation efforts for in-hospital cardiac arrest. Less is known about the role of frailty in survival to discharge after in-hospital cardiopulmonary resuscitation. OBJECTIVE To investigate whether frailty, measured by the Clinical Frailty Scale, is associated with mortality after cardiopulmonary resuscitation following in-hospital cardiac arrest in older adults in the USA. DESIGN Retrospective cohort study. PARTICIPANTS Patients ≥ 65 years who had undergone cardiopulmonary resuscitation during an inpatient admission at two urban academic hospitals and three suburban community hospitals within a Boston area healthcare system from January 2018-January 2020. Patients with Clinical Frailty Scale scores 1-3 were considered not frail, 4-6 were considered very mildly, mildly, and moderately frail, respectively, and 7-9 were considered severely frail. MAIN MEASURES In-hospital mortality after cardiopulmonary resuscitation. KEY RESULTS Among 324 patients who underwent cardiopulmonary resuscitation following in-hospital cardiac arrest, 73.1% experienced in-hospital mortality. Patients with a Clinical Frailty Scale score of 1-3 had 54% in-hospital mortality, which increased to 66%, 78%, 84%, and 84% for those with a Clinical Frailty Scale score of 4, 5, 6, and 7-9, respectively (p = 0.001). After adjusting for age, sex, race, and Charlson Comorbidity Index, higher frailty scores were significantly associated with higher odds of in-hospital mortality. Compared to those with a Clinical Frailty Scale score of 1-3, odds ratios (95% CI) for in-hospital mortality for patients with a Clinical Frailty Scale score of 4, 5, 6, and 7-9 were 1.6 (0.8-3.3), 3.0 (1.3-7.1), 4.4 (1.9-9.9), and 4.6 (1.8-11.8), respectively (p = 0.001). CONCLUSIONS Higher levels of frailty are associated with increased mortality after in-hospital cardiopulmonary resuscitation in older adults. Clinicians may consider using the Clinical Frailty Scale to help guide goals of care conversations, including discussion of code status, in this patient population.
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Affiliation(s)
- Frances Y Hu
- Department of Surgery, Brigham & Women's Hospital, 1620 Tremont Street, Suite 2-016, Boston, MA, 02120, USA.
| | - Shoshana Streiter
- Department of Medicine, Division of Aging, Brigham & Women's Hospital, Boston, MA, USA
| | - Lynne O'Mara
- Department of Surgery, Brigham & Women's Hospital, 1620 Tremont Street, Suite 2-016, Boston, MA, 02120, USA
| | - Stephanie M Sison
- Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Olga Theou
- School of Physiotherapy and Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Rachelle Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ariela Orkaby
- Department of Medicine, Division of Aging, Brigham & Women's Hospital, Boston, MA, USA
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
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24
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Subramaniam A, Shekar K, Anstey C, Tiruvoipati R, Pilcher D. Impact of frailty on clinical outcomes in patients with and without COVID-19 pneumonitis admitted to intensive care units in Australia and New Zealand: a retrospective registry data analysis. Crit Care 2022; 26:301. [PMID: 36192763 PMCID: PMC9527725 DOI: 10.1186/s13054-022-04177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is unclear if the impact of frailty on mortality differs between patients with viral pneumonitis due to COVID-19 or other causes. We aimed to determine if a difference exists between patients with and without COVID-19 pneumonitis. METHODS This multicentre, retrospective, cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database included patients aged ≥ 16 years admitted to 153 ICUs between 01/012020 and 12/31/2021 with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome, and Clinical Frailty Scale (CFS). The primary outcome was hospital mortality. RESULTS A total of 4620 patients were studied, and 3077 (66.6%) had COVID-19. The patients with COVID-19 were younger (median [IQR] 57.0 [44.7-68.3] vs. 66.1 [52.0-76.2]; p < 0.001) and less frail (median [IQR] CFS 3 [2-4] vs. 4 [3-5]; p < 0.001) than non-COVID-19 patients. The overall hospital mortality was similar between the patients with and without COVID-19 (14.7% vs. 14.9%; p = 0.82). Frailty alone as a predictor of mortality showed only moderate discrimination in differentiating survivors from those who died but was similar between patients with and without COVID-19 (AUROC 0.68 vs. 0.66; p = 0.42). Increasing frailty scores were associated with hospital mortality, after adjusting for Australian and New Zealand Risk of Death score and sex. However, the effect of frailty was similar in patients with and without COVID-19 (OR = 1.29; 95% CI: 1.19-1.41 vs. OR = 1.24; 95% CI: 1.11-1.37). CONCLUSION The presence of frailty was an independent risk factor for mortality. However, the impact of frailty on outcomes was similar in COVID-19 patients compared to other causes of viral pneumonitis.
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Affiliation(s)
- Ashwin Subramaniam
- grid.466993.70000 0004 0436 2893Department of Intensive Care, Frankston Hospital, Peninsula Health, Frankston, VIC 3199 Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Monash University, Frankston, VIC Australia ,grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Kiran Shekar
- grid.415184.d0000 0004 0614 0266Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537University of Queensland, Brisbane, QLD Australia ,grid.1033.10000 0004 0405 3820Queensland University of Technology Brisbane and Bond University, Gold Coast, QLD Australia
| | - Christopher Anstey
- grid.1022.10000 0004 0437 5432Griffith University, Gold Coast, QLD Australia
| | - Ravindranath Tiruvoipati
- grid.466993.70000 0004 0436 2893Department of Intensive Care, Frankston Hospital, Peninsula Health, Frankston, VIC 3199 Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Monash University, Frankston, VIC Australia
| | - David Pilcher
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.1623.60000 0004 0432 511XDepartment of Intensive Care, Alfred Hospital, Melbourne, VIC Australia ,grid.489411.10000 0004 5905 1670Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC Australia
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25
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Köller M. [Coronavirus disease 2019 and frailty]. Z Gerontol Geriatr 2022; 55:564-568. [PMID: 36066605 PMCID: PMC9446611 DOI: 10.1007/s00391-022-02101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
Der Verlauf der Coronavirus disease 2019 (COVID-19) ist individuell sehr unterschiedlich. Menschen höheren Lebensalters mit Komorbiditäten sind gefährdeter, schwer zu erkranken oder zu versterben. Gebrechlichkeit (Frailty) ist ein wesentlicher Risikofaktor. Ein Fünftel der Bevölkerung in Mitteleuropa ist älter als 65 Jahre, 10–15 % davon sind als „frail“ anzusehen. Die Pandemie bringt die Gesundheitssysteme vieler Länder an deren Grenzen. Die Entscheidung, welche Patienten noch intensivmedizinisch behandelt werden, führt zu ethischen Diskussionen. Die Clinical Frailty Scale von Rockwood (CFS; CMAJ 173:489–495, 2005) wird in manchen Ländern eingesetzt, diese Entscheidungen zu unterstützen. Von COVID-19 betroffene 80-jährige Patienten haben ein fast 3,6faches Sterblichkeitsrisiko, verglichen mit der Altersgruppe von 18 bis 49 Jahren. Das Risiko gebrechlicher Patienten (CFS-Scores 6–9) ist mehr als 3fach höher als von robusten (CFS-Scores 1–3). Ein CFS-Cut-off-Wert ≥ 6 korreliert mit der Mortalität von COVID-19-Patienten über 65 Jahre. Das mittel- und längerfristige Überleben ist auch mit dem Ausmaß von „Frailty“ vor der Erkrankung und weniger mit dem Schweregrad der COVID-19 assoziiert. Besonders Patienten über 60 Jahre sind gefährdet, bei moderaten und schweren COVID-19-Verläufen rasch Muskelmasse zu verlieren. Patienten auf Intensive Care Units (ICU) verlieren innerhalb von 10 Tagen 20–30 % der Oberschenkelstreckmuskulaturmasse. Das Ausmaß der COVID-19-assoziierten Sarkopenie bestimmt wesentlich den Verlauf der Erkrankung und macht individuelle Rehabilitationsprogrammen erforderlich. Bis zu 50 % der hospitalisierten Patienten benötigen weitere Rehabilitation nach der Entlassung. Aerobes Training mit niedriger Intensität, kombiniert mit Krafttraining, sowie die Sicherstellung einer ausreichenden Energie- und Eiweißzufuhr sind unerlässlich.
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Affiliation(s)
- Marcus Köller
- Abteilung für Akutgeriatrie, Klinikum Favoriten, Kundratstr. 3, 1100, Wien, Österreich.
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26
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Figueiredo FDA, Ramos LEF, Silva RT, Ponce D, de Carvalho RLR, Schwarzbold AV, Maurílio ADO, Scotton ALBA, Garbini AF, Farace BL, Garcia BM, da Silva CTCA, Cimini CCR, de Carvalho CA, Dias CDS, Silveira DV, Manenti ERF, Cenci EPDA, Anschau F, Aranha FG, de Aguiar FC, Bartolazzi F, Vietta GG, Nascimento GF, Noal HC, Duani H, Vianna HR, Guimarães HC, de Alvarenga JC, Chatkin JM, de Morais JDP, Machado-Rugolo J, Ruschel KB, Martins KPMP, Menezes LSM, Couto LSF, de Castro LC, Nasi LA, Cabral MADS, Floriani MA, Souza MD, Souza-Silva MVR, Carneiro M, de Godoy MF, Bicalho MAC, Lima MCPB, Aliberti MJR, Nogueira MCA, Martins MFL, Guimarães-Júnior MH, Sampaio NDCS, de Oliveira NR, Ziegelmann PK, Andrade PGS, Assaf PL, Martelli PJDL, Delfino-Pereira P, Martins RC, Menezes RM, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Sales TLS, Avelino-Silva TJ, Ramires YC, Pires MC, Marcolino MS. Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients. BMC Med 2022; 20:324. [PMID: 36056335 PMCID: PMC9438299 DOI: 10.1186/s12916-022-02503-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
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Affiliation(s)
- Flávio de Azevedo Figueiredo
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil. .,Department of Medicine, Universidade Federal de Lavras, R. Tomas Antonio Gonzaga, 277, Lavras, Brazil.
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Rafael Tavares Silva
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil
| | | | | | | | | | - Andresa Fontoura Garbini
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, R. do Cruzeiro, 01, Teófilo Otoni, Brazil.,Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Cristiane Dos Santos Dias
- Department of Pediatrics, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | | | | | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Filipe Carrilho de Aguiar
- Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Brazil
| | - Frederico Bartolazzi
- Hospital Santo Antônio, Praça Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | | | | | - Helena Carolina Noal
- Hospital Universitário da Universidade Federal de Santa Maria, Av. Roraima, 1000, Santa Maria, Brazil
| | - Helena Duani
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | | | | | | | | | | | - Juliana Machado-Rugolo
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | - Karina Paula Medeiros Prado Martins
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | - Luanna Silva Monteiro Menezes
- Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil.,Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
| | | | | | - Luiz Antônio Nasi
- Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Máderson Alvares de Souza Cabral
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | | | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
| | - Maira Viana Rego Souza-Silva
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Maria Aparecida Camargos Bicalho
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Hospital Júlia Kubitschek, R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil
| | | | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | | | | | | | | | | | - Patricia Klarmann Ziegelmann
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Hospital Tacchini, R. Dr. José Mário Mônaco, 358, Bento Gonçalves, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil
| | | | - Polianna Delfino-Pereira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil
| | | | | | | | | | | | | | - Thaís Lorenna Souza Sales
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, Porto Alegre, 2359, Brazil.,Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, Belo Horizonte, 190, Brazil.,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Na YS, Kim JH, Baek MS, Kim WY, Baek AR, Lee BY, Seong GM, Lee SI. In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19. Acute Crit Care 2022; 37:303-311. [PMID: 35791648 PMCID: PMC9475168 DOI: 10.4266/acc.2022.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly. Methods This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis. Results The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis. Conclusions The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.
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Abey-Nesbit R, Bergler U, Pickering JW, Nishtala PS, Jamieson H. Development and validation of a frailty index compatible with three interRAI assessment instruments. Age Ageing 2022; 51:6653477. [PMID: 35930721 DOI: 10.1093/ageing/afac178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. METHODS deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. RESULTS the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. CONCLUSIONS the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.
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Affiliation(s)
| | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Centre for Therapeutic Innovation, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Halaweh H, Ghannam I. The devastating trio of sarcopenia, frailty, and COVID-19 - A systematic review and meta-analysis. Clin Nutr ESPEN 2022; 51:143-151. [PMID: 36184198 PMCID: PMC9356632 DOI: 10.1016/j.clnesp.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022]
Abstract
Background & aims Sarcopenia, frailty, and COVID-19 appear to be intertwined. Preventive and intervention measures are required to break this link and mitigate the consequences of rising morbidity and mortality among older adults. This study aimed to identify and synthesize important factors related to the interaction of the devastating trio and their impact on the health and mortality of older adults. Methods Data were gathered via searches of PubMed, Cochrane Library, Google Scholar, and Elsevier Mendeley Website. Study selection and data extraction were conducted by the two authors independently. The primary outcome was mortality, secondary outcomes included hospitalization and risk of development of severe disease among older Covid-19 patients. The study results are presented as adjusted odds and hazard ratios with 95% CI. Results A total of 1725 studies were identified through our electronic databases searches. After screening and assessing for eligibility, 39 studies were included in this review, a total of 51,796 patients were included in the systematic review. Our results indicated that frail patients recorded a higher mean age compared to non-frail patients (p < 0.00001), and COVID-19 frail patients had significantly increased mortality rate compared to non-frail patients, the log adjusted OR was 2.10 (1.63, 2.71); I2 = 78%; p < 0.00001. Conclusion Age and frailty are important risk factors for mortality among older adults COVID-19 patients. COVID-19 patients with sarcopenia had a higher risk of developing severe conditions, including hospitalization and ICU admission. Findings that support the use of frailty and sarcopenia indicators to help in the decision-making process for medical care in older adults COVID-19 patients.
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Affiliation(s)
- Hadeel Halaweh
- Faculty of Health Professions, Al-Quds University, Palestine.
| | - Ibrahim Ghannam
- Faculty of Health Professions, Al-Quds University, Palestine
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30
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Pagliuca R, Cupido MG, Mantovani G, Bugada M, Matteucci G, Caffarelli A, Bellotti F, Cocchieri R, Dentale A, Lozzi F, Malagoli P, Morabito P, Serra G, Andreati C. Absence of negativization of nasal swab test and frailty as risk factors for mortality in elderly COVID-19 patients admitted in long-term care facilities. Eur Geriatr Med 2022; 13:933-939. [PMID: 35661341 PMCID: PMC9166148 DOI: 10.1007/s41999-022-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
METHODS A limited amount of data is now available on prognostic factors and mortality among elderly people resident in Long-Term Care facilities and in post-acute units. These populations (in particular those with underlying chronic medical conditions) seem to have higher risk of morbidity and mortality related to COVID-19 disease, but further evidence is needed. The aim of our study is to investigate the impact of some well-known prognostic factors in elderly patients (≥ 65 years) with COVID-19 admitted in the Long-Term Care setting in AUSL Ferrara, Italy. We performed binary regression logistic analysis for some variables (demographic data, clinical data including nasal swab test (NST) at discharge and frailty assessments) to find potential predictors of mortality. We subsequently tested statistically significant variables using Kaplan-Meier curves and Cox-regression models to find survival outcomes and related hazard ratio. RESULTS Risk factors associated with increased mortality resulted NST at discharge, infection, age and frailty. At a further secondary analysis carried out between NST at discharge, age and clinical frailty scale (CFS) < 5, we found a positive correlation between NST at discharge and CFS < 5. Kaplan-Meier curves showed a statistically significant difference regarding frailty and NST at discharge but not for age. CONCLUSION Our study showed that absence of negativization of NST at discharge and frailty are strong predictors for mortality in elderly COVID-19 patients admitted in Long-Term Care facilities, while age and the comorbidity burden are less important.
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Affiliation(s)
- Raffaele Pagliuca
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy.
| | | | - Giacomo Mantovani
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Maura Bugada
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Giulia Matteucci
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Arturo Caffarelli
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Federico Bellotti
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | | | - Antonio Dentale
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Federica Lozzi
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Paola Malagoli
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Pasquale Morabito
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Gianluca Serra
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
| | - Candida Andreati
- Department Medicine, AUSL Ferrara, Via Cassoli, 30, 44121, Ferrara, Italy
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Ntouros PA, Kravvariti E, Vlachogiannis NI, Pappa M, Trougakos IP, Terpos E, Tektonidou MG, Souliotis VL, Sfikakis PP. Oxidative stress and endogenous DNA damage in blood mononuclear cells may predict anti-SARS-CoV-2 antibody titers after vaccination in older adults. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166393. [PMID: 35314351 PMCID: PMC8930778 DOI: 10.1016/j.bbadis.2022.166393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/24/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
Immune senescence in the elderly has been associated with chronic oxidative stress and DNA damage accumulation. Herein we tested the hypothesis that increased endogenous DNA damage and oxidative stress in peripheral blood mononuclear cells of older adults associate with diminished humoral immune response to SARS-CoV-2 vaccination. Increased oxidative stress and DNA double-strand breaks (DSBs) were detected in 9 non-immunocompromised individuals aged 80-96 years compared to 11 adults aged 27-44 years, before, as well as on days 1 and 14 after the first dose, and on day 14 after the second dose of the BNT162B2-mRNA vaccine (all p < 0.05). SARS-CoV-2 vaccination induced a resolvable increase in oxidative stress and DNA damage, but individual DSB-repair efficiency was unaffected by vaccination irrespective of age, confirming vaccination safety. Individual titers of anti-Spike-Receptor Binding Domain (S-RBD)-IgG antibodies, and the neutralizing capacity of circulating anti-SARS-CoV-2 antibodies, measured on day 14 after the second dose in all participants, correlated inversely with the corresponding pre-vaccination endogenous oxidative stress and DSB levels (all p < 0.05). In particular, a strong inverse correlation of individual pre-vaccination DSB levels with both the respective anti-S-RBD-IgG antibodies titers (r = -0.867) and neutralizing capacity of circulating anti-SARS-CoV-2 antibodies (r = -0.983) among the 9 older adults was evident. These findings suggest that humoral responses to SARS-CoV-2 vaccination may be weaker when immune cells are under oxidative and/or genomic stress. Whether such measurements may serve as biomarkers of vaccine efficacy in older adults warrants further studies.
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Affiliation(s)
- Panagiotis A Ntouros
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece; Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Vlachogiannis
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria Pappa
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis P Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vassilis L Souliotis
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece; Institute of Chemical Biology, National Hellenic Research Foundation, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece; Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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32
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Vlachogiannis NI, Baker KF, Georgiopoulos G, Lazaridis C, van der Loeff IS, Hanrath AT, Sopova K, Tual‐Chalot S, Gatsiou A, Spyridopoulos I, Stamatelopoulos K, Duncan CJ, Stellos K. Clinical frailty, and not features of acute infection, is associated with late mortality in COVID-19: a retrospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:1502-1513. [PMID: 35257497 PMCID: PMC9088314 DOI: 10.1002/jcsm.12966] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID-19 patients. METHODS A total of 471 patients with polymerase chain reaction-confirmed COVID-19 were followed up for 9 months [median (inter-quartile range) of follow-up time: 271 (14) days] after hospital admission. COVID-19-related signs and symptoms, laboratory features, co-morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. RESULTS A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval-CI): 4C: 1.34 (1.25-1.45); CFS: 1.49 (1.33-1.66)] and late [OR (95% CI): 4C: 1.23 (1.12-1.36); CFS: 2.04 (1.62-2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732-0.825) vs. 0.723 (0.673-0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776-0.883) vs. 0.724 (0.650-0.798), respectively; P = 0.007]. CONCLUSIONS In our cohort, late mortality in COVID-19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.
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Affiliation(s)
- Nikolaos I. Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kenneth F. Baker
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Georgios Georgiopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Charalampos Lazaridis
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | | | - Aidan T. Hanrath
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Kateryna Sopova
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Simon Tual‐Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Ioakim Spyridopoulos
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Christopher J.A. Duncan
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS)Heidelberg UniversityMannheimGermany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/MannheimMannheimGermany
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33
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Taniguchi LU, Avelino-Silva TJ, Dias MB, Jacob-Filho W, Aliberti MJR. Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19. Crit Care Explor 2022; 4:e0712. [PMID: 35765375 PMCID: PMC9225491 DOI: 10.1097/cce.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Few studies have explored the effect of frailty on the long-term survival of COVID-19 patients after ICU admission. Furthermore, the Clinical Frailty Scale (CFS) validity in critical care patients remains debated. We investigated the association between frailty and 6-month survival in critically ill COVID-19 patients. We also explored whether ICU resource utilization varied according to frailty status and examined the concurrent validity of the CFS in this setting.
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34
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Almeida LKR, Avelino-Silva TJ, de Lima E Silva DC, Campos BA, Varela G, Fonseca CMB, Amorim VL, Piza FMDT, Aliberti MJ, Degani-Costa LH. Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19. J Pain Symptom Manage 2022; 63:680-688. [PMID: 35017017 PMCID: PMC8743276 DOI: 10.1016/j.jpainsymman.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. OBJECTIVE To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. METHODS Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. RESULTS We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO2/FiO2<200 or a C-reactive protein ≥150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. CONCLUSIONS One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
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Affiliation(s)
- Lyna Kyria Rodrigues Almeida
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil
| | - Débora Carneiro de Lima E Silva
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Bruna A Campos
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Gabriela Varela
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Cristina Mara Baghelli Fonseca
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Victor Lp Amorim
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil
| | - Felipe Maia de Toledo Piza
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Marlon Jr Aliberti
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil
| | - Luiza Helena Degani-Costa
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil.
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Seligman B, Charest B, Ho YL, Gerlovin H, Ward RE, Cho K, Driver JA, Gaziano JM, Gagnon DR, Orkaby AR. 30-day Mortality Following COVID-19 and Influenza Hospitalization Among US Veterans Aged 65 and Older. J Am Geriatr Soc 2022; 70:2542-2551. [PMID: 35474510 PMCID: PMC9115089 DOI: 10.1111/jgs.17828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Background COVID‐19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID‐19 and influenza among hospitalized older adults. Methods We conducted a retrospective study of 30‐day mortality among veterans aged 65+ hospitalized with COVID‐19 from March 1, 2020–December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID‐19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims‐based Veterans Affairs Frailty Index (VA‐FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders. Results A total of 15,474 veterans were admitted with COVID‐19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID‐19 and influenza cohorts respectively. Crude 30‐day mortality (95% CI) was 18.9% (18.3%–19.5%) for COVID‐19 and 4.3% (3.8%–4.7%) for influenza. Combining cohorts, the odds ratio for 30‐day mortality from COVID‐19 (versus influenza) was 6.61 (5.74–7.65). There was a statistically significant interaction between infection with COVID‐19 and frailty, but there was no significant interaction between COVID‐19 and age. Separating cohorts, greater 30‐day mortality was significantly associated with older age (p: COVID‐19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID‐19: <0.001, Influenza: <0.001). Conclusion Mortality from COVID‐19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID‐19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
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Affiliation(s)
- Benjamin Seligman
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Geriatrics Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, CA.,Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Hanna Gerlovin
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Rachel E Ward
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane A Driver
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ariela R Orkaby
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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36
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Mak JKL, Hägg S, Eriksdotter M, Annetorp M, Kuja-Halkola R, Kananen L, Boström AM, Kivipelto M, Metzner C, Bäck Jerlardtz V, Engström M, Johnson P, Lundberg LG, Åkesson E, Öberg CS, Olsson M, Cederholm T, Jylhävä J, Religa D. Development of an electronic frailty index for hospitalized older adults in Sweden. J Gerontol A Biol Sci Med Sci 2022; 77:2311-2319. [PMID: 35303746 PMCID: PMC9678204 DOI: 10.1093/gerona/glac069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. METHODS EHRs were extracted for 18,225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from nine geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modelled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. RESULTS 13,188 patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. CONCLUSIONS An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.
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Affiliation(s)
- Jonathan K L Mak
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Martin Annetorp
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Kananen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Carina Metzner
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | | | - Malin Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - Peter Johnson
- Department of Geriatric Medicine, Capio Geriatrik Nacka AB, Nacka, Sweden
| | - Lars Göran Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - Elisabet Åkesson
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden.,Division of Neurogeriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Carina Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - Maria Olsson
- Department of Geriatric Medicine, Capio Geriatrik Löwet, Stockholm, Sweden.,Department of Geriatric Medicine, Capio Geriatrik Sollentuna, Stockholm, Sweden
| | - Tommy Cederholm
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis. Ann Intensive Care 2022; 12:17. [PMID: 35184215 PMCID: PMC8858439 DOI: 10.1186/s13613-021-00977-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The concept of frailty provides an age-independent, easy-to-use tool for risk stratification. We aimed to summarize the evidence on the efficacy of frailty tools in risk assessment in COVID-19 patients. METHODS The protocol was registered (CRD42021241544). Studies reporting on frailty in COVID-19 patients were eligible. The main outcomes were mortality, length of hospital stay (LOH) and intensive care unit (ICU) admission in frail and non-frail COVID-19 patients. Frailty was also compared in survivors and non-survivors. Five databases were searched up to 24th September 2021. The QUIPS tool was used for the risk of bias assessment. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI) using a random effect model. Heterogeneity was assessed using the I2 and χ2 tests. RESULTS From 3640 records identified, 54 were included in the qualitative and 42 in the quantitative synthesis. Clinical Frailty Scale (CFS) was used in 46 studies, the Hospital Frailty Risk Score (HFRS) by 4, the Multidimensional Prognostic Index (MPI) by 3 and three studies used other scores. We found that patients with frailty (CFS 4-9 or HFRS ≥ 5) have a higher risk of mortality (CFS: OR: 3.12; CI 2.56-3.81; HFRS OR: 1.98; CI 1.89-2.07). Patients with frailty (CFS 4-9) were less likely to be admitted to ICU (OR 0.28, CI 0.12-0.64). Quantitative synthesis for LOH was not feasible. Most studies carried a high risk of bias. CONCLUSIONS As determined by CFS, frailty is strongly associated with mortality; hence, frailty-based patient management should be included in international COVID-19 treatment guidelines. Future studies investigating the role of frailty assessment on deciding ICU admission are strongly warranted.
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Nucci RAB, Jacob-Filho W. The “Long COVID” Respiratory Symptoms—Concerns with Frailty and Respiratory Diseases. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1742467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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39
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Zou Y, Han M, Wang J, Zhao J, Gan H, Yang Y. Predictive value of frailty in the mortality of hospitalized patients with COVID-19: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:166. [PMID: 35280387 PMCID: PMC8908186 DOI: 10.21037/atm-22-274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Abstract
Background The present study aimed to analyze the impact of frailty on mortality risk among hospitalized patients with coronavirus disease 2019 (COVID-19). Methods Literature searches were conducted using the MEDLINE, Embase, and Cochrane databases for articles reporting the association between frailty and mortality in hospitalized patients with COVID-19. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). A random-effects meta-analysis was performed to calculate the pooled effects. Results A total of 21 studies with 26,652 hospitalized patients were included. Sixteen studies used the Clinical Frailty Score (CFS), and five used other frailty assessment tools. The pooled estimates of frailty in hospitalized patients with COVID-19 were 51.4% [95% confidence interval (CI): 39.9–62.9%]. In the CFS group, frail patients experienced a higher rate of short-term mortality than non-frail patients [odds ratio (OR) =3.0; 95% CI: 2.3–3.9; I2=72.7%; P<0.001]. In the other tools group, frail patients had a significantly increased short-term mortality risk compared with non-frail patients (OR =2.4; 95% CI: 1.4–4.1; P=0.001). Overall, a higher short-term mortality risk was observed for frail patients than non-frail patients (OR =2.8; 95% CI: 2.3–3.5; P<0.001). In older adults, frail patients had a higher rate of short-term mortality than non-frail patients (OR =2.3; 95% CI: 1.8–2.9; P<0.001). Conclusions Compared to non-frail hospitalized patients with COVID-19, frail patients suffered a higher risk of all-cause mortality, and this result was also found in the older adult group.
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Affiliation(s)
- Yupei Zou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Maonan Han
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huatian Gan
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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40
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Seiffert P, Konka A, Kasperczyk J, Kawa J, Lejawa M, Maślanka-Seiffert B, Zembala-John J, Bugdol M, Romanik M, Bułdak R, Marcisz C, Derejczyk J, Religa D. Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status. Biogerontology 2022; 23:53-64. [PMID: 34923608 PMCID: PMC8684786 DOI: 10.1007/s10522-021-09944-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Clinical and biological assessment of the COVID-19 vaccine efficacy in the frail population is of crucial importance. The study focuses on measuring the levels of anti-SARS-CoV-2 IgG antibodies before and after BNT162b2 mRNA COVID-19 vaccination among long-term care facility (LTCF) elderly residents. We conducted a prospective, single-center, observational study among LTCF residents. The study protocol was based on three blood sample acquisitions: first taken at baseline-5 days before the first dose of the vaccine, second-20 days after the first dose, and third-12 days after the second shot of the vaccine. The comparison was made for two cohorts: patients with and without prior COVID-19 infection. The data was collected from January to March 2021. A total number of 78 LTCF residents (55 women and 23 men) aged 62-104, 85.72 ± 7.59 years (mean ± SD), were enrolled in the study. All study participants were investigated for the presence of SARS-CoV-2 anti-spike (S) protein IgG, using a chemiluminescent immunoassay. Frailty was assessed with the Clinical Frailty Scale. Among elderly COVID-19 survivors in LTCF, a single dose of vaccine significantly increased anti-SARS-CoV-2 IgG antibody levels. IgG concentration after a single and double dose was comparable, which may suggest that elderly COVID-19 survivors do not require a second dose of vaccine. For residents without a previous history of COVID-19, two doses are needed to achieve an effective serological response. The level of anti-SARS-CoV-2 IgG antibodies after vaccination with BNT162b2 mRNA COVID-19 did not correlate with the frailty and age of the studied individuals.
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Affiliation(s)
- Piotr Seiffert
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Rheumatology Ward, Murcki Hospital, Katowice, Poland
| | - Adam Konka
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
| | - Janusz Kasperczyk
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Kawa
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Mateusz Lejawa
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Joanna Zembala-John
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Center for Heart Diseases, Zabrze, Poland
| | - Monika Bugdol
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Małgorzata Romanik
- Department of Medical Microbiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Rafał Bułdak
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Czesław Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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41
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Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors. Crit Care Med 2022; 50:955-963. [PMID: 35081061 PMCID: PMC9112506 DOI: 10.1097/ccm.0000000000005488] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs.
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42
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Subramaniam A, Shekar K, Afroz A, Ashwin S, Billah B, Brown H, Kundi H, Lim ZJ, Ponnapa Reddy M, Curtis JR. Frailty and mortality associations in patients with
COVID
‐19: A Systematic Review and Meta‐analysis. Intern Med J 2022; 52:724-739. [PMID: 35066970 PMCID: PMC9314619 DOI: 10.1111/imj.15698] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
Background Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. Aim To examine associations between frailty and short‐term mortality in patients hospitalised with coronavirus disease 2019 (COVID‐19). Methods In this systematic review and meta‐analysis, we searched PubMed, Embase and the COVID‐19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID‐19 (age ≥18 years) were included. Data on patient demographics, short‐term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle−Ottawa Scale. Results Twenty‐five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06–1.11) and had more comorbidities. Fifty‐eight percent of patients were frail. Adjusting for age, there was no difference in short‐term mortality between frail and non‐frail patients (RR = 1.04; 95% CI: 0.84–1.28). The non‐frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30–2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non‐frail (RR = 1.62; 95% CI 0.93–2.77). Conclusion This systematic review did not demonstrate an independent association between frailty status and short‐term mortality in patients with COVID‐19. Patients with frailty were less commonly admitted to ICU and non‐frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Monash University, Peninsula Clinical School Frankston Victoria Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital Brisbane Queensland Australia
- University of Queensland, Brisbane; Queensland University of Technology Brisbane and Bond University Gold Coast Queensland Australia
| | - Afsana Afroz
- Centre for Integrated Critical Care, Department of Medicine and Radiology Melbourne Medical School Melbourne Victoria Australia
| | - Sushma Ashwin
- Department of Health Economics School of Health and social development, Deakin University Melbourne Victoria Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Hamish Brown
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
| | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Zheng Jie Lim
- Department of Anaesthesiology, Austin Health Heidelberg Victoria Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Department of Intensive Care Medicine, Calvary Hospital Canberra Australian Capital Territory Australia
| | - J Randall Curtis
- Cambia Palliative Care Centre of Excellence University of Washington Seattle Washington United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University of Washington Seattle Washington United States of America
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Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis. Crit Care Explor 2022; 4:e0616. [PMID: 35072081 PMCID: PMC8769107 DOI: 10.1097/cce.0000000000000616] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Supplemental Digital Content is available in the text. Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.
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Avelino-Silva VI, de Barros MTL. Assessment of novel technologies in healthcare - off-label use of drugs and the ethics of implementation and distribution of COVID-19 vaccines. EINSTEIN-SAO PAULO 2022; 19:eED6840. [PMID: 35019043 PMCID: PMC8693880 DOI: 10.31744/einstein_journal/2021ed6840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Vivian Iida Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mario Thadeu Leme de Barros
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Class 8 FICSAE Working Group
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Boreskie KF, Hay JL, Boreskie PE, Arora RC, Duhamel TA. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr 2022; 22:13. [PMID: 34979966 PMCID: PMC8722007 DOI: 10.1186/s12877-021-02722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.
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Affiliation(s)
- Kevin F Boreskie
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Patrick E Boreskie
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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46
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DeVito LM, Barzilai N, Cuervo AM, Niedernhofer LJ, Milman S, Levine M, Promislow D, Ferrucci L, Kuchel GA, Mannick J, Justice J, Gonzales MM, Kirkland JL, Cohen P, Campisi J. Extending human healthspan and longevity: a symposium report. Ann N Y Acad Sci 2022; 1507:70-83. [PMID: 34498278 PMCID: PMC10231756 DOI: 10.1111/nyas.14681] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022]
Abstract
For many years, it was believed that the aging process was inevitable and that age-related diseases could not be prevented or reversed. The geroscience hypothesis, however, posits that aging is, in fact, malleable and, by targeting the hallmarks of biological aging, it is indeed possible to alleviate age-related diseases and dysfunction and extend longevity. This field of geroscience thus aims to prevent the development of multiple disorders with age, thereby extending healthspan, with the reduction of morbidity toward the end of life. Experts in the field have made remarkable advancements in understanding the mechanisms underlying biological aging and identified ways to target aging pathways using both novel agents and repurposed therapies. While geroscience researchers currently face significant barriers in bringing therapies through clinical development, proof-of-concept studies, as well as early-stage clinical trials, are underway to assess the feasibility of drug evaluation and lay a regulatory foundation for future FDA approvals in the future.
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Affiliation(s)
| | - Nir Barzilai
- Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Sofiya Milman
- Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - George A Kuchel
- University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Jamie Justice
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mitzi M Gonzales
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | | | - Pinchas Cohen
- USC Leonard Davis School of Gerontology, Los Angeles, California
| | - Judith Campisi
- The Buck Institute for Research on Aging, Novato, California
- Lawrence Berkeley National Laboratory, Berkley, California
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47
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Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010671. [PMID: 34682421 PMCID: PMC8535841 DOI: 10.3390/ijerph182010671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 12/22/2022]
Abstract
Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2.
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Covino M, Russo A, Salini S, De Matteis G, Simeoni B, Della Polla D, Sandroni C, Landi F, Gasbarrini A, Franceschi F. Frailty Assessment in the Emergency Department for Risk Stratification of COVID-19 Patients Aged ≥80 Years. J Am Med Dir Assoc 2021; 22:1845-1852.e1. [PMID: 34364846 PMCID: PMC8289672 DOI: 10.1016/j.jamda.2021.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission. DESIGN Single-center prospective observational cohort study. SETTING AND PARTICIPANTS The study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021. METHODS Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes. RESULTS A total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death. CONCLUSIONS AND IMPLICATIONS The ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation.
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Affiliation(s)
- Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore-Roma, Rome, Italy.
| | - Andrea Russo
- Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Sara Salini
- Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Benedetta Simeoni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Davide Della Polla
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Claudio Sandroni
- Università Cattolica del Sacro Cuore-Roma, Rome, Italy; Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Landi
- Università Cattolica del Sacro Cuore-Roma, Rome, Italy; Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore-Roma, Rome, Italy; Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore-Roma, Rome, Italy
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49
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Engvig A, Wyller TB, Skovlund E, Ahmed MV, Hall TS, Rockwood K, Njaastad AM, Neerland BE. Association between clinical frailty, illness severity and post-discharge survival: a prospective cohort study of older medical inpatients in Norway. Eur Geriatr Med 2021; 13:453-461. [PMID: 34417977 PMCID: PMC8379589 DOI: 10.1007/s41999-021-00555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
Aim To assess impact of frailty screening and two markers of illness severity on survival following discharge from the hospital. Findings Independently of age, ward (acute geriatric and general medical) and comorbidity, both higher degree of frailty and illness severity associated with reduced survival probability following discharge. The impact of frailty on survival was higher in those experiencing high clinical and laboratory illness severity. Message The prognostic value of frailty screening increased when performed in conjunction with two markers of illness severity. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00555-8. Purpose Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Methods Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after discharge. Ward physicians screened for frailty and quantified its degree from one to eight using Clinical Frailty Scale (CFS), while clinical illness severity was estimated by New Early Warning Score 2 (NEWS2) and laboratory illness severity was calculated by a frailty index (FI-lab) using routine blood tests. Results CFS, NEWS2 and FI-lab scores were independently associated with post-discharge survival in an adjusted Cox proportional hazards model with age, ward category (acute geriatric and general medical) and comorbidity as covariates. Adjusted hazard ratios and 95% confidence intervals were 1.54 (1.24–1.91) for CFS, 1.12 (1.03–1.23) for NEWS2, and 1.02 (1.00–1.05) for FI-lab. A frailty × illness severity category interaction effect (p = 0.003), suggested that the impact of frailty on survival was greater in those experiencing higher levels of illness severity. Among patients with at least moderate frailty (CFS six to eight) and high illness severity according to both NEWS2 and FI-lab, two (13%) were alive at follow-up. Conclusion Frailty screening aided prognostication of survival following discharge in older acutely ill persons admitted to medical wards. The prognostic value of frailty increased when combined with readily available illness severity markers acquired during admission. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00555-8.
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Affiliation(s)
- Andreas Engvig
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway. .,Department of Nephrology, Division of Medicine, Oslo University Hospital, Ullevål Hospital, Nydalen, PO Box 4956, 0424, Oslo, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo (UiO), Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Trygve Sundby Hall
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway
| | | | - Anne Mette Njaastad
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway
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50
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Berjeaut EJBK, de Carvalho BM, Aliberti MJR, Avelino-Silva TJ, Campora F, Jacob-Filho W, Garcez FB. "Part of a great team": Perceptions of geriatrics fellows on doing research during a pandemic. J Am Geriatr Soc 2021; 69:3058-3061. [PMID: 34343345 DOI: 10.1111/jgs.17397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Eugênia Jatene Bou Khazaal Berjeaut
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruna Macêdo de Carvalho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - 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, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, 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, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saude Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Flavia Campora
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 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, Sao Paulo, Brazil
| | - 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, Sao Paulo, Brazil
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