Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain.
Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain.
Eur Geriatr Med. 2021 Dec;12(6):1169-1180. doi: 10.1007/s41999-021-00541-0. Epub 2021 Jul 21.
To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients.
Single-center observational study.
Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19.
Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality.
Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was < 60 in 127 patients (42.8%) and 126 (42.0%) had Charlson Index CI ≥ 3. Most patients (216; 72.7%) were frail (Clinical Frailty Scale ≥ 5) and 134 patients (45.1%) had dementia of some degree. The overall in-hospital mortality rate was 37%. The following factors were associated with higher in-hospital mortality in a multi-variant analysis: CURB-65 score = 3-5 (HR 7.99, 95% CI 3.55-19.96, p < 0.001), incident delirium (HR 1.72, 1.10-2.70, p = 0.017) and dementia (HR 3.01, 95% CI 1.37-6.705, p = 0.017). Protective factors were concurrent use of angiotensin-converting enzyme inhibitors (HR 0.42, 95% CI 0.25-0.72, p = 0.002) or prescription of hydroxychloroquine (HC 0.37 95% CI 0.22-0.62, p < 0.001) treatment during admission.
Our findings suggest that recognition of geriatric syndromes together with the CURB-65 score may be useful tools to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19.
确定与 COVID-19 相关的超高龄患者院内死亡的预测因素。
单中心观察性研究。
入住急性老年科病房的≥75 岁的 COVID-19 患者。
从电子病历中检索入院时的数据：人口统计学、老年综合征（谵妄、跌倒、多重用药、功能和认知状态）合并症、既往治疗、临床、实验室和影像学特征。使用 Cox 比例风险模型评估院内死亡率。
连续纳入 300 例患者（62.7%为女性，平均年龄 86.3±6.6 岁）。127 例（42.8%）患者的巴氏指数（BI）<60，126 例（42.0%）患者的 Charlson 指数（CI）≥3。大多数患者（216 例；72.7%）虚弱（临床虚弱量表≥5），134 例（45.1%）有不同程度的痴呆。总的院内死亡率为 37%。多变量分析显示以下因素与更高的院内死亡率相关：CURB-65 评分=3-5（HR 7.99，95%CI 3.55-19.96，p<0.001）、新发谵妄（HR 1.72，1.10-2.70，p=0.017）和痴呆（HR 3.01，95%CI 1.37-6.705，p=0.017）。保护因素是同时使用血管紧张素转换酶抑制剂（HR 0.42，95%CI 0.25-0.72，p=0.002）或羟氯喹（HC）治疗（HR 0.37，95%CI 0.22-0.62，p<0.001）。
我们的研究结果表明，识别老年综合征加上 CURB-65 评分可能是帮助临床医生确定因 COVID-19 住院的超高龄患者预后的有用工具。
Zotero 插件