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. 2023 Sep 6;11(9):2473.
doi: 10.3390/biomedicines11092473.

Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis

Francesco Spannella  1   2 , Federico Giulietti  1 , Giorgia Laureti  1   2 , Mirko Di Rosa  3 , Chiara Di Pentima  1 , Massimiliano Allevi  1   2 , Caterina Garbuglia  1   2 , Piero Giordano  1 , Matteo Landolfo  1   2 , Letizia Ferrara  4 , Alessia Fumagalli  5 , Fabrizia Lattanzio  6 , Anna Rita Bonfigli  6 , Riccardo Sarzani  1   2
Affiliations

Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis

Francesco Spannella et al. Biomedicines. .

Abstract

Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83-91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28-3.01)] and 3 [HR 2.87 (95% CI: 1.62-5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient.

Keywords: COVID-19; NT-proBNP; SARS-CoV-2; cluster; in-hospital mortality; older adults.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Log-rank test for equality of survivor functions: χ2 = 30.01; p < 0.001.
Figure 2
Figure 2
Accuracy comparison for Cluster and CFS.
See this image and copyright information in PMC

References

    1. Sarzani R., Allevi M., Giulietti F., Di Pentima C., Re S., Giordano P., Spannella F. The Identikit of Patient at Risk for Severe COVID-19 and Death: The Dysregulation of Renin-Angiotensin System as the Common Theme. J. Clin. Med. 2021;10:5883. doi: 10.3390/jcm10245883. - DOI - PMC - PubMed
    1. Corradini E., Ventura P., Ageno W., Cogliati C.B., Muiesan M.L., Girelli D., Pirisi M., Gasbarrini A., Angeli P., Querini P.R., et al. Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: Results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI) Intern. Emerg. Med. 2021;16:1005–1015. doi: 10.1007/s11739-021-02742-8. - DOI - PMC - PubMed
    1. Wei C., Liu Y., Liu Y., Zhang K., Su D., Zhong M., Meng X. Clinical characteristics and manifestations in older patients with COVID-19. BMC Geriatr. 2020;20:395. doi: 10.1186/s12877-020-01811-5. - DOI - PMC - PubMed
    1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z., Xiang J., Wang Y., Song B., Gu X., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Sarzani R., Spannella F., Giulietti F., Fedecostante M., Giordano P., Gattafoni P., Espinosa E., Busco F., Piccinini G., Dessi-Fulgheri P. NT-proBNP and its correlation with in-hospital mortality in the very elderly without an admission diagnosis of heart failure. PLoS ONE. 2016;11:e0153759. doi: 10.1371/journal.pone.0153759. - DOI - PMC - PubMed