scholarly journals Age-Specific Changes in Virulence Associated with SARS-CoV-2 Variants of Concern

2021 ◽  
Author(s):  
David N. Fisman ◽  
Ashleigh R. Tuite
Keyword(s):  
Age Groups ◽  
Relative Increase ◽  
Adverse Outcomes ◽  
Older Individuals ◽  
Term Care ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Risk Of Death ◽  
Novel Variants ◽  
Increase In Risk

AbstractBackgroundNovel variants of concern (VOCs) have been associated with both increased infectivity and virulence of SARS-CoV-2. The virulence of SARS-CoV-2 is closely linked to age. Whether relative increases in virulence of novel VOCs is similar across the age spectrum, or is limited to some age groups, is unknown.MethodsWe created a retrospective cohort of people in Ontario, Canada testing positive for SARS-CoV-2 and screened for VOCs, with dates of test report between February 7 and August 30, 2021 (n=233,799). Cases were classified as N501Y-positive VOC, probable Delta VOC, or VOC undetected. We constructed age-specific logistic regression models to evaluate the effects of N501Y-postive or Delta VOC infections on infection severity, using hospitalization, intensive care unit (ICU) admission, and death as outcome variables. Models were adjusted for sex, time, health unit, vaccination status, comorbidities, immune compromise, long-term care residence, healthcare worker status, and pregnancy.ResultsInfection with either N501Y-positive or Delta VOCs was associated with significant elevations in risk of hospitalization, ICU admission, and death in younger and older adults, compared to infections where a VOC was not detected. Delta VOC increased hospitalization risk in children under 10 by a factor of 2.5 (adjusted odds ratio, 95% confidence interval: 1.2 to 5.1) compared to non-VOC. For most VOC-outcome combinations there was no heterogeneity in adverse outcomes by age. However, there was an inverse relationship between age and relative increase in risk of death with delta VOC, with younger age groups showing a greater relative increase in risk of death than older individuals.InterpretationSARS-CoV-2 VOCs appear to be associated with increased relative virulence of infection in all age groups, though low absolute numbers of outcomes in younger individuals make estimates in these groups imprecise.

scholarly journals Adaptive metabolic and inflammatory responses identified using accelerated aging metrics are linked to adverse outcomes in severe SARS-CoV-2 infection

2021 ◽  
Author(s):  
Alejandro Márquez-Salinas ◽  
Carlos A Fermín-Martínez ◽  
Neftalí Eduardo Antonio-Villa ◽  
Arsenio Vargas-Vázquez ◽  
Enrique C. Guerra ◽  
...  
Keyword(s):  
Critical Illness ◽  
Proportional Hazards ◽  
Inflammatory Responses ◽  
Age Groups ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Adaptive Responses ◽  
Predictive Capacity ◽  
Risk Of Death

Abstract Background Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components. Methods In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components. Results We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel>0 had higher risk of death and critical illness compared to those with lower values (log-rank p<0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes. Conclusions Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.

scholarly journals Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19

2021 ◽  
Author(s):  
Pandora L. Wander ◽  
Elliott Lowy ◽  
Lauren A. Beste ◽  
Luis Tulloch-Palomino ◽  
Anna Korpak ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Veterans Health ◽  
Health Administration ◽  
Glucose Lowering ◽  
Lower Odds ◽  
Icu Admission ◽  
Risk Of Death ◽  
Insulin Use

<b>Objective: </b>To identify pre-infection risk factors for adverse outcomes among Veterans with diabetes mellitus and COVID-19 infection. <p><b> </b></p> <p><b>Research design and methods: </b>We identified all Veterans Health Administration patients with diabetes and ≥1 positive nasal swab for SARS-CoV-2 (March 1, 2020–March 10, 2021) (n=64,892). We examined associations of HbA1c and glucose-lowering medication use with hospitalization, ICU admission, and mortality at 30 days using logistic regression models and over 4.4 months of follow-up (range <1–13.1 months) using proportional hazards models.</p> <p><b> </b></p> <p><b>Results: </b>Compared to HbA1c <7.0%, HbA1c ≥9.0% was associated with higher odds of hospitalization, ICU admission and death at 30 days as well as higher risk of death over 4.4 months (OR 1.27[95%CI 1.19–1.35], 1.28[95%CI 1.15–1.42], 1.30[95%CI 1.17–1.44]; HR 1.22[95%CI 1.12–1.32). Insulin use was associated with higher odds of hospitalization, ICU admission and death (OR 1.12[95%CI 1.07–1.18], 1.12[95%CI 1.04–1.22], and 1.18[95%CI 1.09–1.27]) and higher risk of death (HR 1.12[95%CI 1.07–1.18]). Sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP1-RA), or angiotensin receptor blocker (ARB) use were associated with lower odds of hospitalization (OR 0.92[95%CI 0.85–0.99], OR 0.88[95%CI 0.81–0.96], and 0.94[95%CI 0.89–0.99]). Metformin and SGLT2i use were associated with lower odds and risk of death (OR 0.84[95%CI 0.78–0.91], 0.82[95%CI 0.72–0.94]; HR 0.84[95%CI 0.79–0.89], 0.82[95%CI 0.74–0.92).</p> <p> </p> <b>Conclusions: </b>Among Veterans with diabetes and COVID-19, higher HbA1c and insulin use were directly associated with adverse outcomes, while use of a GLP1-RA, metformin, and SGLT2i were inversely associated.

scholarly journals Age and Hospitalization Risk in People with Type 1 Diabetes and COVID-19: Data from the T1D Exchange Surveillance Study

2021 ◽  
Author(s):  
Carla Demeterco-Berggren ◽  
Osagie Ebekozien ◽  
Saketh Rompicherla ◽  
Laura Jacobsen ◽  
Siham Accacha ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Age Groups ◽  
The United States ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Study Population ◽  
Few Data

Abstract Context COVID-19 morbidity and mortality are increased in type 1 diabetes (T1D), but few data focus on age-based outcomes. Objective To quantify the risk for COVID-19 related hospitalization and adverse outcomes by age in people with T1D. Design, Setting and Patients For this observational, multisite, cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 56 clinical sites in the United States, data were collected from April 2020 to March 2021. The distribution of patient factors and outcomes across age groups (0-18, 19-40 and &gt; 40 years) was examined. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, adverse outcomes, and hospitalization. Main Outcome Measures Hospitalization for COVID-19. Results A total of 767 patients were analyzed. Fifty-four percent (n=415) were aged 0-18 years, thirty-two percent (n=247) were aged 19-40 years and fourteen percent (n=105) were aged &gt;40 years. One-hundred and seventy patients were hospitalized, and 5 patients died. Compared to the 0-18 years age group, those &gt;40 years of age had an adjusted odds ratio of 4.2 (95% confidence interval 2.28-7.83) for hospitalization after adjustment for gender, A1c, race, insurance type and comorbidities. Conclusions Age &gt;40 years is a risk factor for patients with T1D and COVID-19, with children and younger adults experiencing milder disease and better prognosis. This indicates a need for age-tailored treatments, immunization, and clinical management of individuals affected by T1D.

scholarly journals Prior Glucose-Lowering Medication Use and 30-Day Outcomes Among 64,892 Veterans With Diabetes and COVID-19

2021 ◽  
Author(s):  
Pandora L. Wander ◽  
Elliott Lowy ◽  
Lauren A. Beste ◽  
Luis Tulloch-Palomino ◽  
Anna Korpak ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Veterans Health ◽  
Health Administration ◽  
Glucose Lowering ◽  
Lower Odds ◽  
Icu Admission ◽  
Risk Of Death ◽  
Insulin Use

<b>Objective: </b>To identify pre-infection risk factors for adverse outcomes among Veterans with diabetes mellitus and COVID-19 infection. <p><b> </b></p> <p><b>Research design and methods: </b>We identified all Veterans Health Administration patients with diabetes and ≥1 positive nasal swab for SARS-CoV-2 (March 1, 2020–March 10, 2021) (n=64,892). We examined associations of HbA1c and glucose-lowering medication use with hospitalization, ICU admission, and mortality at 30 days using logistic regression models and over 4.4 months of follow-up (range <1–13.1 months) using proportional hazards models.</p> <p><b> </b></p> <p><b>Results: </b>Compared to HbA1c <7.0%, HbA1c ≥9.0% was associated with higher odds of hospitalization, ICU admission and death at 30 days as well as higher risk of death over 4.4 months (OR 1.27[95%CI 1.19–1.35], 1.28[95%CI 1.15–1.42], 1.30[95%CI 1.17–1.44]; HR 1.22[95%CI 1.12–1.32). Insulin use was associated with higher odds of hospitalization, ICU admission and death (OR 1.12[95%CI 1.07–1.18], 1.12[95%CI 1.04–1.22], and 1.18[95%CI 1.09–1.27]) and higher risk of death (HR 1.12[95%CI 1.07–1.18]). Sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP1-RA), or angiotensin receptor blocker (ARB) use were associated with lower odds of hospitalization (OR 0.92[95%CI 0.85–0.99], OR 0.88[95%CI 0.81–0.96], and 0.94[95%CI 0.89–0.99]). Metformin and SGLT2i use were associated with lower odds and risk of death (OR 0.84[95%CI 0.78–0.91], 0.82[95%CI 0.72–0.94]; HR 0.84[95%CI 0.79–0.89], 0.82[95%CI 0.74–0.92).</p> <p> </p> <b>Conclusions: </b>Among Veterans with diabetes and COVID-19, higher HbA1c and insulin use were directly associated with adverse outcomes, while use of a GLP1-RA, metformin, and SGLT2i were inversely associated.

scholarly journals Adaptive metabolic and inflammatory responses identified using accelerated aging metrics are linked to adverse outcomes in severe SARS-CoV-2 infection

2020 ◽  
Author(s):  
Alejandro Márquez-Salinas ◽  
Carlos A. Fermín-Martínez ◽  
Neftalí Eduardo Antonio-Villa ◽  
Arsenio Vargas-Vázquez ◽  
Enrique C. Guerra ◽  
...  
Keyword(s):  
Critical Illness ◽  
Proportional Hazards ◽  
Inflammatory Responses ◽  
Age Groups ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Adaptive Responses ◽  
Predictive Capacity ◽  
Risk Of Death

ABSTRACTINTRODUCTIONChronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components.METHODSIn this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge/PhenoAccelAge components.RESULTSWe included 1068 subjects of whom 401 presented critical illness and 204 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel>0 had higher risk of death and critical illness compared to those with lower values (log-rank p<0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes.CONCLUSIONSAdaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.

scholarly journals Does Identifying Frailty from ICD-10 Coded Data on Hospital Admission Improve Prediction of Adverse Outcomes in Older Surgical Patients

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Lara Harvey ◽  
Barbara Toson ◽  
Ian Harris ◽  
Robert Gandy ◽  
Jacqueline Close
Keyword(s):  
External Validation ◽  
Age Groups ◽  
Information Criterion ◽  
Population Based ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Surgical Specialty ◽  
Prolonged Length ◽  
Logistic Regression Models ◽  
Poor Outcomes

IntroductionAs the population ages, increasing numbers of older adults are undergoing surgery. Outcomes for older people are known to be worse than younger people following surgical procedures, and identifying which patients stand to benefit from surgery can be challenging. Frailty is recognised as a major contributor to poor outcomes, however assessing frailty clinically is time-consuming and not routinely undertaken. Using data available from electronic medical records can potentially provide the opportunity to routinely screen for frailty electronically at time of admission. Objectives and ApproachThis population-based external validation study aimed to: 1. assess the performance of the Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes (mortality, prolonged length of stay (LOS) and 28-day readmission), 2. to determine optimal age-groups and lookback periods and 3. compare HFRS performance against the Charlson Comorbidity Index (CCI). Hospital and death data for individuals (n=487,197) aged >50 years admitted under a surgical specialty to all public/private hospitals in NSW, Australia, 2013-2017 were linked. Logistic regression models were tested for each outcome of interest. Area under receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed for each model. ResultsFor prediction of 30-day, all models performed better than age and sex alone; however adjusting for CCI (AUC 0.76) provided marginally better prediction than adjusting for HFRS (AUC 0.75). Models consistently performed better in the younger age-group (50-65), providing excellent discrimination (AUC 0.82). In contrast, all models had poor ability to predict prolonged-LOS (AUC range 0.62- 0.63) or readmission (AUC range 0.62-0.65). Using a 5-year lookback period did not improve model discrimination over using a 2-year period. Conclusion / ImplicationsAdjusting for frailty using the HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged-LOS r 28-day unplanned readmission.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

Assessment of ST2 for Risk of Death Following Graft-versus-Host Disease in the Pediatric and Adult Age Groups

2019 ◽  
Author(s):  
Courtney Rowan ◽  
Francis Pike ◽  
Kenneth R. Cooke ◽  
Robert Krance ◽  
Paul A. Carpenter ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Age Groups ◽  
Host Disease ◽  
Adult Age ◽  
Graft Versus Host ◽  
Risk Of Death

scholarly journals Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zijing Wang ◽  
Wenjia Peng ◽  
Mengying Li ◽  
Xinghui Li ◽  
Tingting Yang ◽  
...  
Keyword(s):  
Older People ◽  
Functional Disability ◽  
Long Term Care ◽  
Strong Association ◽  
Binary Logistic Regression ◽  
Term Care ◽  
Logistic Regression Models ◽  
Disease Pattern ◽  
Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

scholarly journals Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044384
Author(s):  
Guduru Gopal Rao ◽  
Alexander Allen ◽  
Padmasayee Papineni ◽  
Liyang Wang ◽  
Charlotte Anderson ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severe Infection ◽  
Older Age ◽  
Cross Sectional ◽  
North West ◽  
Icu Admission ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

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