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Observational Study
. 2023 Jul;40(7):643-651.
doi: 10.1007/s40266-023-01036-2. Epub 2023 Jun 13.

The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study

Carlo Custodero  1 , Nicola Veronese  2 , Eva Topinkova  3   4 , Helena Michalkova  3   4 , Maria Cristina Polidori  5 , Alberto Cella  6 , Alfonso J Cruz-Jentoft  7 , Christine A F von Arnim  8 , Margherita Azzini  9 , Heidi Gruner  10 , Alberto Castagna  11 , Giovanni Cenderello  12 , Romina Custureri  6 , Tania Zieschang  13 , Alessandro Padovani  14 , Elisabet Sanchez-Garcia  7 , Alberto Pilotto  1   6 ; Study Group Investigators
Collaborators, Affiliations
Observational Study

The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study

Carlo Custodero et al. Drugs Aging. 2023 Jul.

Abstract

Background: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored.

Objective: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir.

Methods: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50.

Results: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use.

Conclusions: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.

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Conflict of interest statement

Christine A.F. von Arnim received honoraria from serving on the scientific advisory boards of Biogen, Roche, Novo Nordisk, and Dr. Willmar Schwabe GmbH &Co. KG; funding for travel and speaker honoraria from Biogen, Roche Diagnostics AG, Novartis, Medical Tribune Verlagsgesellschaft GmbH, Landesvereinigung für Gesundheit und Akademie für Sozialmedizin Niedersachsen e. V. and Dr. Willmar Schwabe GmbH &Co. KG; and has received research support from Roche Diagnostics AG. Funding was received from Innovationsfond (Fund of the Federal Joint Committee, Gemeinsamer Bundesausschuss, G-BA Grants No. VF1_2016-201; 01NVF21010; 01VSF21019). Carlo Custodero, Nicola Veronese, Eva Topinkova, Helena Michalkova, Maria Cristina Polidori, Alberto Cella, Alfonso J. Cruz-Jentoft, Margherita Azzini, Heidi Gruner, Alberto Castagna, Giovanni Cenderello, Romina Custureri, Tania Zieschang, Alessandro Padovani, Elisabet Sanchez-Garcia, and Alberto Pilotto declare they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Survival analysis by use or non-use of remdesivir in participants with an MPI < 0.50 and MPI > 0.50, during 90 days of follow-up. The graphs are the result of a Cox regression analysis, adjusted for potential confounders. MPI Multidimensional Prognostic Index
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