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Multicenter Study
. 2022 Jun 30;22(1):546.
doi: 10.1186/s12877-022-03191-4.

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Jose-Manuel Ramos-Rincon  1 , Lidia Cobos-Palacios  2 , Almudena López-Sampalo  2 , Michele Ricci  2 , Manel Rubio-Rivas  3 , Maria-Victoria Nuñez-Rodriguez  4 , Rodrigo Miranda-Godoy  5 , Maria-Eugenia García-Leoni  6 , Rosa Fernández-Madera-Martínez  7 , Gema-María García-García  8 , Jose-Luis Beato-Perez  9 , Daniel Monge-Monge  10 , Uxua Asín-Samper  11 , Marta Bustamante-Vega  12 , Isabel Rábago-Lorite  13 , Santiago-Jesús Freire-Castro  14 , Jose-Pablo Miramontes-González  15 , Jeffrey-Oskar Magallanes-Gamboa  16 , José-Nicolás Alcalá-Pedrajas  17 , Miriam García-Gómez  18 , Verónica Cano-Llorente  19 , Francisco-Javier Carrasco-Sánchez  20 , Jesús Martinez-Carrilero  21 , Juan-Miguel Antón-Santos  22 , Ricardo Gómez-Huelgas  2   23 ; SEMI-COVID-19 Network
Affiliations
Multicenter Study

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Jose-Manuel Ramos-Rincon et al. BMC Geriatr. .

Abstract

Background: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain.

Methods: This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR).

Results: Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79).

Conclusions: Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

Keywords: 80 and over; Aged; COVID-19; Comorbidity; Complications; Epidemiology; Morbidity; Mortality; SARS-CoV-2; Spain.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Probability of survival in the first and successive waves
Fig. 2
Fig. 2
Probability of survival in the first and successive waves by age group (80–84, 85–89, 90–94, and 95 years)
See this image and copyright information in PMC

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