Current best evidence for clinical care (more info)
INTRODUCTION: To date, mainly due to age-related vulnerability and to coexisting comorbidities, older patients often face a more severe COVID-19. This study aimed to identify at Emergency Department (ED) admission the predictors of in-hospital mortality and suitable scores for death risk stratification among COVID-19 patients = 80 years old.
METHODS: Single-centre prospective study conducted in the ED of an university hospital, referral center for COVID-19 in central Italy. We included 239 consecutive patients = 80 years old with laboratory-confirmed COVID-19. The primary study endpoint was all-cause in-hospital mortality. Multivariable Cox regression analysis was performed on significant variables at univariate analysis to identify independent risk factor for death. Overall performance in predicting mortality of WHO severity scale, APACHE II score, NEWS score, and CURB-65 was calculated.
RESULTS: Median age was 85 [82-89] and 112 were males (46.9%). Globally, 77 patients (32.2%) deceased. The presence of consolidations at chest x-ray and the hypoxemic respiratory failure were significant predictors of poor prognosis. Moreover, age = 85 years, dependency in activities of daily living (ADL), and dementia were risk factors for death, even after adjusting for clinical covariates and disease severity. All the evaluated scores showed a fairly good predictive value in identifying patients who could experience a worse outcome.
CONCLUSIONS: Among patients = 80 years old hospitalized with COVID-19, not only a worse clinical and radiological presentation of the disease, but also the increasing age, dementia, and impairment in ADL were strong risk factors for in-hospital death, regardless of disease severity.
|Discipline / Specialty Area||Score|
This prospective study evaluated the utility of risk factors in determining mortality in geriatric patients with COVID-19. Dementia, decreased the ability to perform ADLs and age were all criteria associated with worse outcomes. In addition, hypoxemic respiratory failure or infiltrates on chest radiograph at presentation were both associated with worse outcomes as well.
Being hospitalists, we have seen higher mortality in elderly and longer LOS because of various factors, but it is good to see objective evidence provided by such studies to confirm it.