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[老年及高龄住院新冠肺炎呼吸道疾病患者的死亡率及相关预后因素]

[Mortality and associated prognostic factors in elderly and very elderly hospitalized patients with respiratory disease COVID-19].

作者信息

Águila-Gordo Daniel, Martínez-Del Río Jorge, Mazoteras-Muñoz Virginia, Negreira-Caamaño Martín, Nieto-Sandoval Martín de la Sierra Patricia, Piqueras-Flores Jesús

机构信息

Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.

Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.

出版信息

Rev Esp Geriatr Gerontol. 2021 Sep-Oct;56(5):259-267. doi: 10.1016/j.regg.2020.09.006. Epub 2020 Nov 11.

Abstract

INTRODUCTION

Elderly patients with COVID-19 has a worse clinical evolution, being more susceptible to develop serious manifestations. The differences between the elderly and very elderly population, mortality and associated prognostic factors of SARS-CoV-2 infection have not been enough studied yet.

METHODS

An observational study of 416 elderly patients admitted consecutively to Hospital General Universitario de Ciudad Real for COVID-19 respiratory infection from March 1st to April 30th, 2020. Data were collected including patient demographic information, medical history, clinical characteristics, laboratory data, therapeutic interventions and clinical outcomes during the hospitalization and after discharge, until June 15, 2020 with the aim of analyzing mortality, and associated prognostic factors.

RESULTS

The mean age was 84.43±5.74 years old; elderly patients (75-84 years) were 50.2% of the sample and very elderly (≥85 years) the remaining 49.8%. In Cox regression model, mortality rate was higher in very elderly group (HR = 2.58; 95% CI: 1.23-5.38; P = .01), hypertensive (HR = 3, 45; 95% CI: 1.13-10.5; P = .03) and chronic kidney disease patients (HR = 3.86; 95% CI: 1.3-11.43; P = .02). In contrast, calcium antagonists (HR = 0.27; 95% CI: 0.12-0.62; P = .002) and anticoagulant therapy during hospitalization (HR = 0.26; 95% CI: 0.08 0, 83; P = .02) were associated with a longer time free of mortality.

CONCLUSIONS

Mortality rate was higher in very eldery patients compared with eldery; and in hypertensive and chronic kidney disease patients. Anticoagulation therapy and calcium chanel bloquers treatment during hospitalization were associated with a higher survival in the short-term follow-up in patients hospitalized with COVID-19.

摘要

引言

新型冠状病毒肺炎(COVID-19)老年患者的临床病程更差,更容易出现严重表现。老年与高龄人群之间的差异、严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的死亡率及相关预后因素尚未得到充分研究。

方法

对2020年3月1日至4月30日因COVID-19呼吸道感染连续入住雷阿尔城大学综合医院的416例老年患者进行观察性研究。收集患者的人口统计学信息、病史、临床特征、实验室数据、治疗干预措施以及住院期间和出院后的临床结局,直至2020年6月15日,旨在分析死亡率及相关预后因素。

结果

平均年龄为84.43±5.74岁;老年患者(75-84岁)占样本的50.2%,高龄患者(≥85岁)占其余的49.8%。在Cox回归模型中,高龄组的死亡率更高(风险比[HR]=2.58;95%置信区间[CI]:1.23-5.38;P=0.01),高血压患者(HR=3.45;95%CI:1.13-10.5;P=0.03)和慢性肾脏病患者(HR=3.86;95%CI:1.3-11.43;P=0.02)也是如此。相比之下,钙拮抗剂(HR=0.27;95%CI:0.12-0.62;P=0.002)和住院期间的抗凝治疗(HR=0.26;95%CI:0.08-0.83;P=0.02)与更长的无死亡时间相关。

结论

与老年患者相比,高龄患者以及高血压和慢性肾脏病患者的死亡率更高。住院期间的抗凝治疗和钙通道阻滞剂治疗与COVID-19住院患者短期随访中的较高生存率相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b247/7656995/64d2c01dfd61/gr1_lrg.jpg

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