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Observational Study
. 2021 Dec;12(6):1169-1180.
doi: 10.1007/s41999-021-00541-0. Epub 2021 Jul 21.

Mortality risk factors in a Spanish cohort of oldest-old patients hospitalized with COVID-19 in an acute geriatric unit: the OCTA-COVID study

Affiliations
Observational Study

Mortality risk factors in a Spanish cohort of oldest-old patients hospitalized with COVID-19 in an acute geriatric unit: the OCTA-COVID study

Isabel Lozano-Montoya et al. Eur Geriatr Med. 2021 Dec.

Abstract

Purpose: To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients.

Design: Single-center observational study.

Setting and participants: Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19.

Methods: Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality.

Results: Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was < 60 in 127 patients (42.8%) and 126 (42.0%) had Charlson Index CI ≥ 3. Most patients (216; 72.7%) were frail (Clinical Frailty Scale ≥ 5) and 134 patients (45.1%) had dementia of some degree. The overall in-hospital mortality rate was 37%. The following factors were associated with higher in-hospital mortality in a multi-variant analysis: CURB-65 score = 3-5 (HR 7.99, 95% CI 3.55-19.96, p < 0.001), incident delirium (HR 1.72, 1.10-2.70, p = 0.017) and dementia (HR 3.01, 95% CI 1.37-6.705, p = 0.017). Protective factors were concurrent use of angiotensin-converting enzyme inhibitors (HR 0.42, 95% CI 0.25-0.72, p = 0.002) or prescription of hydroxychloroquine (HC 0.37 95% CI 0.22-0.62, p < 0.001) treatment during admission.

Conclusions and implications: Our findings suggest that recognition of geriatric syndromes together with the CURB-65 score may be useful tools to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19.

Keywords: Covid-19; Mortality; Older adults; Risk factors; SARS-COV-2.

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Conflict of interest statement

The authors have declared no conflict of interest for this article and no financial conflicts.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves Delirium (Long-Rank: p = 0.001)
Fig. 2
Fig. 2
Kaplan–Meier survival curves CURB-65 (Long-Rank: p < 0.001)

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