老年 COVID-19 住院患者院内死亡的临床特征和预测因素。
Clinical profile and predictors of in-hospital mortality among older patients hospitalised for COVID-19.
机构信息
Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain.
Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
出版信息
Age Ageing. 2021 Feb 26;50(2):326-334. doi: 10.1093/ageing/afaa258.
BACKGROUND
the coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients.
METHODS
post hoc analysis of the international, multicentre, 'real-world' HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65-74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality.
RESULTS
about, 1,520 patients aged ≥65 years (60.3% male, median age of 76 [IQR 71-83] years) were included. Comorbidities such as hypertension (69.2%), dyslipidaemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8.06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm3) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality.
CONCLUSION
patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population.
背景
2019 年冠状病毒病（COVID-19）的特点是预后不良和死亡率高，尤其是在老年患者中。
方法
对国际多中心真实世界 HOPE COVID-19 注册研究进行事后分析。选择所有因 COVID-19 住院的年龄≥65 岁的患者。获取流行病学、临床、分析和结局数据。对年龄在 65-74 岁和≥75 岁的两个亚组进行比较研究。主要终点为全因住院死亡率。
结果
共纳入 1520 名年龄≥65 岁（60.3%为男性，中位年龄为 76[IQR 71-83]岁）的患者。高血压（69.2%）、血脂异常（48.6%）、心血管疾病（任何慢性心脏病占 38.4%，脑血管疾病占 12.5%）和慢性肺部疾病（25.3%）等合并症较为常见，49.6%的患者服用 ACEI/ARB。75 岁及以上的患者发生院内并发症（呼吸衰竭、心力衰竭、肾衰竭、败血症）更多，死亡率显著更高（18.4% vs. 48.2%，P<0.001），但入住重症监护病房的比例较低（11.2% vs. 4.8%）。在整个队列中，多变量分析表明年龄≥75 岁（OR 3.54）、慢性肾脏病（OR 3.36）、痴呆（OR 8.06）、入院时外周血氧饱和度<92%（OR 5.85）、严重淋巴细胞减少症（<500/mm3）（OR 3.36）和 qSOFA（快速序贯器官衰竭评估评分）>1（OR 8.31）是死亡率的独立预测因素。
结论
因 COVID-19 住院的年龄≥65 岁的患者发生院内并发症和死亡率较高，尤其是 75 岁及以上的患者。年龄≥75 岁、痴呆、外周血氧饱和度<92%、严重淋巴细胞减少症和 qSOFA 评分>1 是该人群死亡的独立预测因素。
Zotero 插件