Critical and Intensive Care Medicine, Hospital Universitario Mayor-Méderi, Bogotá, Colombia.
Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá́, Colombia.
BMC Geriatr. 2024 Oct 26;24(1):878. doi: 10.1186/s12877-024-05411-5.
Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).
This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.
A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.
The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
由于 2019 年冠状病毒病（COVID-19），年龄增长与急性呼吸窘迫综合征（ARDS）患者的死亡率增加有关。本研究旨在确定与 COVID-19 相关的 ARDS（C-ARDS）相关的 60 岁以上患者住院死亡的危险因素。
这是一项观察性、分析性、回顾性研究，纳入了 2020 年 3 月至 2021 年 7 月期间在哥伦比亚波哥大一家高复杂性医院住院的所有年龄在 60 岁或以上、诊断为 COVID-ARDS 的患者。
共纳入 1563 例患者，中位年龄为 73 岁（四分位距 [IQR]：67-80），死亡 811 例（51.8%）。住院死亡的独立危险因素包括：71-80 岁患者[比值比（OR）1.87（95%可信区间 [CI]：1.33-2.64]）]，年龄＞80 岁[OR 8.74（95% CI：5.34-14.31）]，乳酸脱氢酶（LDH）[OR 1.009（95% CI：1.003-1.0015）]，严重的 C-ARDS[OR 2.16（95% CI：1.50-3.11）]，使用有创机械通气（IMV）[OR 12.94（95% CI：9.52-17.60）]，和使用类固醇[OR 1.49（95% CI：1.09-2.03）]。在 80 岁以上的患者（n=388）中，与住院死亡相关的主要危险因素是使用 IMV（n=76）[OR 6.26（95% CI：2.67-14.69）]，导致住院死亡率为 89.4%（n=68）。
60 岁以上患者住院死亡的主要危险因素是年龄、使用 IMV、C-ARDS 严重程度、使用类固醇和 LDH 值升高。在 80 岁以上的患者中，住院死亡的主要危险因素是使用 IMV。对于老年患者的 C-ARDS，应始终个体化决定是否启动 IMV；因此，可以考虑使用替代氧输送系统作为一线治疗方法。
