Emergency Department - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Internal Medicine - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Arch Gerontol Geriatr. 2021 Jul-Aug;95:104383. doi: 10.1016/j.archger.2021.104383. Epub 2021 Feb 25.
To date, mainly due to age-related vulnerability and to coexisting comorbidities, older patients often face a more severe COVID-19. This study aimed to identify at Emergency Department (ED) admission the predictors of in-hospital mortality and suitable scores for death risk stratification among COVID-19 patients ≥ 80 years old.
Single-centre prospective study conducted in the ED of an university hospital, referral center for COVID-19 in central Italy. We included 239 consecutive patients ≥ 80 years old with laboratory-confirmed COVID-19. The primary study endpoint was all-cause in-hospital mortality. Multivariable Cox regression analysis was performed on significant variables at univariate analysis to identify independent risk factor for death. Overall performance in predicting mortality of WHO severity scale, APACHE II score, NEWS score, and CURB-65 was calculated.
Median age was 85 [82-89] and 112 were males (46.9%). Globally, 77 patients (32.2%) deceased. The presence of consolidations at chest x-ray and the hypoxemic respiratory failure were significant predictors of poor prognosis. Moreover, age ≥ 85 years, dependency in activities of daily living (ADL), and dementia were risk factors for death, even after adjusting for clinical covariates and disease severity. All the evaluated scores showed a fairly good predictive value in identifying patients who could experience a worse outcome.
Among patients ≥ 80 years old hospitalized with COVID-19, not only a worse clinical and radiological presentation of the disease, but also the increasing age, dementia, and impairment in ADL were strong risk factors for in-hospital death, regardless of disease severity.
迄今为止，由于年龄相关的脆弱性和并存的合并症，老年患者往往面临更严重的 COVID-19。本研究旨在确定在急诊科（ED）入院时，预测 COVID-19 患者≥80 岁住院死亡率的指标，以及适合 COVID-19 患者死亡风险分层的评分。
这是一项在意大利中部 COVID-19 转诊中心的大学医院 ED 进行的单中心前瞻性研究。我们纳入了 239 例连续的实验室确诊 COVID-19 患者，年龄均≥80 岁。主要研究终点为全因住院死亡率。对单变量分析中具有统计学意义的变量进行多变量 Cox 回归分析，以确定死亡的独立危险因素。计算 WHO 严重程度评分、APACHE II 评分、NEWS 评分和 CURB-65 在预测死亡率方面的整体表现。
中位年龄为 85[82-89]岁，男性 112 例（46.9%）。总体而言，77 例（32.2%）患者死亡。胸部 X 线检查存在实变和低氧性呼吸衰竭是预后不良的显著预测因素。此外，年龄≥85 岁、日常生活活动（ADL）依赖和痴呆是死亡的危险因素，即使在调整了临床协变量和疾病严重程度后也是如此。所有评估的评分在识别可能出现更差结局的患者方面均具有相当好的预测价值。
在因 COVID-19 住院的≥80 岁患者中，不仅疾病的临床表现和影像学表现更差，而且年龄的增加、痴呆和 ADL 受损是住院死亡的强烈危险因素，与疾病严重程度无关。
