Abstract
Senility has been identified among the strongest risk predictors for unfavorable COVID-19-outcome. However, even in the elderly population, the clinical course of infection in individual patients remains unpredictable. Hence, there is an urgent need for developing a simple tool predicting adverse COVID-19-outcomes. We assumed that the C2HEST-score could predict unfavorable clinical outcomes in the elderly subjects with COVID-19-subjects. Methods: We retrospectively analyzed 1047 medical records of patients at age > 65 years, hospitalized at the medical university center due to COVID-19. Subsequently, patients were divided into three categories depending on their C2HEST-score result. Results: We noticed significant differences in the in-hospital and 3-month and 6-month mortality-which was the highest in high-risk-C2HEST-stratum reaching 35.7%, 54.4%, and 65.9%, respectively. The medium-risk-stratum mortalities reached 24.1% 43.4%, and 57.6% and for low-risk-stratum 14.4%, 25.8%, and 39.2% respectively. In the C2HEST-score model, a change from the low to the medium category increased the probability of death intensity approximately two-times. Subsequently, transfer from the low-risk to the high-risk-stratum raised all-cause-death-intensity 2.7-times. Analysis of the secondary outcomes revealed that the C2HEST-score has predictive value for acute kidney injury, acute heart failure, and cardiogenic shock. Conclusions: C2HEST-score analysis on admission to the hospital may predict the mortality, acute kidney injury, and acute heart failure in elderly subjects with COVID-19.
Highlights
IntroductionThe novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing Coronavirus disease 2019 (COVID-19), firstly described as a local cluster of pneumonia in Wuhan, Hubei, China [1], despite initial widespread use of preventive measures for personal protection [2], has spread worldwide and evolved into a global pandemic, affecting healthcare systems all over the world
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing Coronavirus disease 2019 (COVID-19), firstly described as a local cluster of pneumonia in Wuhan, Hubei, China [1], despite initial widespread use of preventive measures for personal protection [2], has spread worldwide and evolved into a global pandemic, affecting healthcare systems all over the world. many risk factors for the disease progression have been identified, clinical course of infection in individual patients remains still uncertain
One of the recent studies, based on the small cohort (n=91) suggests that elderly patients (>60 years) classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19—super vulnerability was an independent predictor of death and the need for invasive mechanical ventilation during hospitalization— a final VES-13 score between 8 and 10 was associated with poor outcomes [17]
Summary
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing Coronavirus disease 2019 (COVID-19), firstly described as a local cluster of pneumonia in Wuhan, Hubei, China [1], despite initial widespread use of preventive measures for personal protection [2], has spread worldwide and evolved into a global pandemic, affecting healthcare systems all over the world. Many risk factors for the disease progression have been identified, clinical course of infection in individual patients remains still uncertain. Despite the high risk attributed to this subpopulation, clinical experience indicates that the course of COVID-19 is heterogeneous, ranging from asymptomatic to fatal cases. Facing limited resources during COVID-19 pandemic, adequate selection of patients with the highest probability of unfavorable outcome is crucial for designing individualized diagnostic and therapeutic strategy
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