Abstract
Background: Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission.
Methods: We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1-May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission.
Results: A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index < 60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n: 1301) and increased with age (80-84 years: 41.6%; 85-90 years: 47.3%; 90-94 years: 52.7%; ≥95 years: 54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: oxygen saturation < 90%; temperature ≥ 37.8°C; quick sequential organ failure assessment (qSOFA) score ≥ 2; and unilateral-bilateral infiltrates on chest x-rays. Some analytical findings were independent risk factors for death, including estimated glomerular filtration rate < 45 mL/min/1.73 m2; lactate dehydrogenase ≥ 500 U/L; C-reactive protein ≥ 80 mg/L; neutrophils ≥ 7.5 × 103/μL; lymphocytes < 0.8 × 103/μL; and monocytes < 0.5 × 103/μL.
Conclusions: This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status-not comorbidities-are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.
Keywords: Age ≥ 80; COVID-19; Mortality; Prognostic factors; SARS-CoV-2.
【저자키워드】 COVID-19, SARS-CoV-2, Mortality, Prognostic factors, Age ≥ 80, 【초록키워드】 SARS-CoV-2, Hospitalized, Clinical characteristics, hospital, neutrophil, Diabetes Mellitus, Comorbidity, C-reactive protein, cardiovascular disease, risk factor, lactate dehydrogenase, monocyte, lymphocyte, oxygen saturation, Dementia, Cohort, Chest, Patient, death, age, temperature, predictor, multicenter, registry, Admission, in-hospital mortality, glomerular filtration rate, retrospective, Analysis, Male sex, Organ failure, Predictive, qSOFA, In-hospital, Inpatient, Primary outcome, atherosclerotic, median age, multivariate logistic regression, poor prognosis, Barthel Index, independent risk factor, Spanish, men, analyzed, identify, Rate, overall case-fatality rate, conducted, was performed, functional, consecutive patient, with COVID-19, 【제목키워드】 clinical, Spain, Factor,