健康脆弱性与 COVID-19 老年患者不良结局的关联:一项前瞻性队列研究。

Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study.

机构信息

Departamento de Clinica Medica, Disciplina de Medicina de Emergencia, Faculdade de Medicina, Universidade de Brasília (UnB), Brasilia, DF, BR.

Time de Resposta Rapida, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

出版信息

Clinics (Sao Paulo). 2021 Dec 6;76:e3369. doi: 10.6061/clinics/2021/e3369. eCollection 2021.

Abstract

OBJECTIVES

Health vulnerability is associated with a higher risk of mortality and functional decline in older people in the community. However, few studies have evaluated the role of the Vulnerable Elders Survey (VES-13) in predicting clinical outcomes of hospitalized patients. In the present study, we tested the ability of the VES-13 to predict mortality and the need for invasive mechanical ventilation in older people hospitalized with coronavirus disease 2019 (COVID-19).

METHODS

This prospective cohort included 91 participants aged ≥60 years who were confirmed to have COVID-19. VES-13 was applied, and the demographic, clinical, and laboratory variables were collected within 72h of hospitalization. A Poisson generalized linear regression model with robust variance was used to estimate the relative risk of death and invasive mechanical ventilation.

RESULTS

Of the total number of patients, 19 (21%) died and 15 (16%) required invasive mechanical ventilation. Regarding health vulnerability, 54 (59.4%) participants were classified as non-vulnerable, 30 (33%) as vulnerable, and 7 (7.6%) as extremely vulnerable. Patients classified as extremely vulnerable and male sex were strongly and independently associated with a higher relative risk of in-hospital mortality (p<0.05) and need for invasive mechanical ventilation (p<0.05).

CONCLUSION

Elderly patients classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19. These data highlight the importance of identifying health vulnerabilities in this population.

摘要

目的

健康脆弱性与社区中老年人的死亡率和功能下降风险增加相关。然而,很少有研究评估脆弱性老年人调查(VES-13)在预测 2019 年冠状病毒病(COVID-19)住院患者临床结局中的作用。本研究旨在测试 VES-13 在预测 COVID-19 住院老年人死亡率和需要有创机械通气方面的能力。

方法

这是一项前瞻性队列研究,纳入了 91 名年龄≥60 岁的 COVID-19 确诊患者。在入院后 72 小时内应用 VES-13,并收集人口统计学、临床和实验室变量。使用具有稳健方差的泊松广义线性回归模型来估计死亡和有创机械通气的相对风险。

结果

在所有患者中,19 例(21%)死亡,15 例(16%)需要有创机械通气。在健康脆弱性方面,54 例(59.4%)患者被归类为非脆弱,30 例(33%)为脆弱,7 例(7.6%)为极度脆弱。极度脆弱和男性被归类为与住院期间死亡率(p<0.05)和需要有创机械通气(p<0.05)的更高相对风险密切相关。

结论

COVID-19 住院后,被归类为极度脆弱的老年患者预后更差。这些数据突出了在该人群中识别健康脆弱性的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7610/8610221/cfb9b2dc0cde/cln-76-e3369-g001.jpg

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