Abstract
BackgroundThe primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID-19 remain unclear.ObjectiveTo determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19.MethodThis was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death.ResultsThe mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03–9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99–8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21–33.88; 0.029)], and hemoglobin < 12 g/mL [OR: 3.32 (1.20–9.20; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation [OR: 26.72 (3.87–184.11; 0.001)], cancer history [OR:8.32 (1.28–53.91; 0.026)] and IL-6 > 40 pg/mL [OR:10.01 (1.66–60.13; 0.012)] were independent predictors of death.ConclusionIn hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death.
Highlights
The COVID-19 pandemic has been characterized by severe impacts on the elderly population, who suffered high hospitalization rates, unfavorable clinical evolution, and substantial mortality [1]
In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03–9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99–8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21–33.88; 0.029)], and hemoglobin < 12 g/mL [OR: 3.32 (1.20–9.20; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation [OR: 26.72 (3.87–184.11; 0.001)], cancer history [OR:8.32 (1.28–53.91; 0.026)] and interleukin 6 (IL-6) > 40 pg/ mL [OR:10.01 (1.66–60.13; 0.012)] were independent predictors of death
Variables evaluated with adjustment: Age > 80 Adj = individuals aged 80 years or more; CKD Adj = chronic kidney disease; computed tomography (CT) scan Adj = lung involvement over 50%; Marital status Adj; Atrial Fib Adj = prior atrial fibrillation, Vitamin D Adj = vitamin D < 40 ng/dl; IL-6 Adj = interleukin 6 > 40 pg/mL, CRP Adj = C-reactive protein> 80 mg/L; D dimer Adj = d dimer> 1000 ng/ml, Hemoglobin Adj = hemoglobin< 12 g/mL; AST Adj = aspartate aminotransferase > 50 U/mL; Creatinine Adj = creatinine > 1.1 mg/dL; Myoglobin Adj = myoglobin> 65 ng/mL)
Summary
The COVID-19 pandemic has been characterized by severe impacts on the elderly population, who suffered high hospitalization rates, unfavorable clinical evolution, and substantial mortality [1]. In the United States, older adults accounted for 31% of cases with clinical manifestations, 45% of hospitalizations, and 53% of admissions. Acute respiratory distress syndrome is the primary clinical manifestation of severe disease and the strongest predictor of mortality from COVID-19, especially when requiring mechanical ventilation [2]. Age above 65 years is an independent predictor for acute respiratory distress syndrome [3], and this could be caused by the dysfunction of the immune system associated with aging, with exacerbated inflammatory reactions and decreased anti-inflammatory responses (Inflammaging) [4]. The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID19 remain unclear
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