Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Arch Gerontol Geriatr. 2021 May-Jun;94:104331. doi: 10.1016/j.archger.2020.104331. Epub 2020 Dec 24.
Older adults with COVID-19 have disproportionately higher rates of severe disease and mortality. It is unclear whether this is attributable to age or attendant age-associated risk factors. This retrospective cohort study aims to characterize hospitalized older adults and examine if comorbidities, frailty and acuity of clinical presentation exert an age-independent effect on COVID-19 severity.
We studied 275 patients admitted to the National Centre of Infectious Disease, Singapore. We measured: 1)Charlson Comorbidity Index(CCI) as burden of comorbidities; 2)Clinical Frailty Scale(CFS) and Frailty Index(FI); and 3)initial acuity. We studied characteristics and outcomes of critical illness, stratified by age groups (50-59,60-69 and ≥70). We conducted hierarchical logistic regression in primary model(N = 262, excluding direct admissions to intensive care unit) and sensitivity analysis(N = 275): age and gender in base model, entering CCI, frailty (CFS or FI) and initial acuity sequentially.
The ≥70 age group had highest CCI(p<.001), FI(p<.001) and CFS(p<.001), and prevalence of geriatric syndromes (polypharmacy,53.5%; urinary symptoms,37.5%; chronic pain,23.3% and malnutrition,23.3%). Thirty-two (11.6%) developed critical illness. In the primary regression model, age was not predictive for critical illness when a frailty predictor was added. Significant predictors in the final model (AUC 0.809) included male gender (p=.012), CFS (p=.038), and high initial acuity (p=.021) but not CCI or FI. In sensitivity analysis, FI (p=.028) but not CFS was significant.
In hospitalized older adults with COVID-19, geriatric syndromes are not uncommon. Acuity of clinical presentation and frailty are important age-independent predictors of disease severity. CFS and FI provide complimentary information in predicting interval disease progression and rapid disease progression respectively.
患有 COVID-19 的老年人患有严重疾病和死亡的比例过高。目前尚不清楚这是归因于年龄还是伴随的年龄相关危险因素。这项回顾性队列研究旨在描述住院的老年人，并研究合并症、虚弱和临床表现的严重程度是否对 COVID-19 的严重程度产生与年龄无关的影响。
我们研究了 275 名入住新加坡国家传染病中心的患者。我们测量了：1）Charlson 合并症指数（CCI）作为合并症负担；2）临床虚弱量表（CFS）和虚弱指数（FI）；3）初始严重程度。我们研究了危重病的特征和结局，并按年龄组（50-59、60-69 和≥70）进行分层。我们在主要模型（N=262，不包括直接入住重症监护病房的患者）和敏感性分析（N=275）中进行了分层逻辑回归：基础模型中的年龄和性别，依次输入 CCI、虚弱（CFS 或 FI）和初始严重程度。
≥70 岁年龄组的 CCI（p<.001）、FI（p<.001）和 CFS（p<.001）最高，以及老年综合征的患病率（多药治疗，53.5%；尿症状，37.5%；慢性疼痛，23.3%和营养不良，23.3%）。32 名（11.6%）患者发展为危重病。在主要回归模型中，当加入虚弱预测因素时，年龄对危重病无预测作用。最终模型中的显著预测因素（AUC 0.809）包括男性（p=.012）、CFS（p=.038）和初始高严重程度（p=.021），但不是 CCI 或 FI。在敏感性分析中，FI（p=.028）但不是 CFS 有意义。
在患有 COVID-19 的住院老年人中，老年综合征并不少见。临床表现的严重程度和虚弱是疾病严重程度的重要与年龄无关的预测因素。CFS 和 FI 分别提供了预测疾病进展间隔和快速疾病进展的补充信息。
