Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes.

Abstract Background: The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the outcome of the disease in this group of patients, admitted to our Hospital in RomeMethods: This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to May 2020, divided in two groups according to their age (Elderly: 65-80 years old; Very Elderly >80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH)s and clinical outcomes. Results: We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease. Conclusion: We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.

Download Full-text

Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes

BMC Geriatrics ◽

10.1186/s12877-021-02013-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. D’ascanio ◽

M. Innammorato ◽

L. Pasquariello ◽

D. Pizzirusso ◽

G. Guerrieri ◽

...

Keyword(s):

Mortality Rate ◽

Elderly Patients ◽

Clinical Outcomes ◽

Residential Care ◽

Pneumonia Severity Index ◽

Care Homes ◽

Categorical Variables ◽

Rank Test ◽

Very Elderly ◽

Arterial Blood

Abstract Background The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the outcome of the disease in this group of patients, admitted to our Hospital in Rome. Methods This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to May 2020, divided in two groups according to their age (Elderly: 65–80 years old; Very Elderly > 80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH) s and clinical outcomes. Results We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease. Conclusion We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.

Download Full-text

Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes.

10.21203/rs.3.rs-42681/v2 ◽

2020 ◽

Author(s):

Michela D'Ascanio ◽

Marta Innammorato ◽

Lara Pasquariello ◽

Dario Pizzirusso ◽

Giulio Guerrieri ◽

...

Keyword(s):

Mortality Rate ◽

Elderly Patients ◽

Clinical Outcomes ◽

Residential Care ◽

Pneumonia Severity Index ◽

Care Homes ◽

Categorical Variables ◽

Rank Test ◽

Very Elderly ◽

Arterial Blood

Download Full-text

Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes.

10.21203/rs.3.rs-42681/v1 ◽

2020 ◽

Author(s):

Michela D'Ascanio ◽

Marta Innammorato ◽

Lara Pasquariello ◽

Dario Pizzirusso ◽

Giulio Guerrieri ◽

...

Keyword(s):

Elderly Patients ◽

Residential Care ◽

Pneumonia Severity Index ◽

University Hospital ◽

Care Homes ◽

Categorical Variables ◽

Rank Test ◽

Continuous Variables ◽

Very Elderly ◽

Arterial Blood

Abstract Background: The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the evolution of the disease in this group of patients, admitted to our Hospital in RomeMethods: This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to may 2020, divided in two groups according to their age (G1 65-80 years old; G2 >80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariable Cox proportional hazard regression and ordinal logistic regression were performed to estimate associations between age, comorbidities and provenance from residential care homes and clinical outcomes.Results: We found that G2 patients had an increased mortaliy rate, also due to (the frequent prevalence of) multiple comorbidities. Moreover we found that patients coming from long-stay residential care homes appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease.Conclusion: We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes; moreover, to establish a correct risk stratification, comorbidities and information about provenience from residential care homes should be considered.

Download Full-text

Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000600010 ◽

2011 ◽

Vol 19 (6) ◽

pp. 1344-1351 ◽

Cited By ~ 3

Author(s):

Verônica Cunha Rodrigues de Oliveira ◽

Lilia de Souza Nogueira ◽

Rafaela Andolhe ◽

Katia Grillo Padilha ◽

Regina Marcia Cardoso de Sousa

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Elderly Patients ◽

Comparative Study ◽

Clinical Outcomes ◽

Intensive Care Units ◽

The Elderly ◽

Simplified Acute Physiology Score ◽

Adult Patients ◽

Very Elderly

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥18 and <60 years), 216 elderly (≥60 and <80 years) and 105 very elderly (≥80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.

Download Full-text

Impact of vanA-Positive Enterococcus faecium Exhibiting Diverse Susceptibility Phenotypes to Glycopeptides on 30-Day Mortality of Patients with a Bloodstream Infection

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02180-19 ◽

2020 ◽

Vol 64 (7) ◽

Author(s):

Dokyun Kim ◽

Eun-Jeong Yoon ◽

Jun Sung Hong ◽

Hyukmin Lee ◽

Kyeong Seob Shin ◽

...

Keyword(s):

Logistic Regression ◽

Mortality Rate ◽

Bloodstream Infection ◽

Clinical Outcomes ◽

Enterococcus Faecium ◽

Rank Test ◽

Content Type ◽

Multicenter Observational Study ◽

Multivariable Logistic Regression ◽

Significant Difference

ABSTRACT This study was performed to evaluate the impacts of vanA positivity of Enterococcus faecium exhibiting diverse susceptibility phenotypes to glycopeptides on clinical outcomes in patients with a bloodstream infection (BSI) through a prospective, multicenter, observational study. A total of 509 patients with E. faecium BSI from eight sentinel hospitals in South Korea during a 2-year period were enrolled in this study. Risk factors of the hosts and causative E. faecium isolates were assessed to determine associations with the 30-day mortality of E. faecium BSI patients via multivariable logistic regression analyses. The vanA gene was detected in 35.2% (179/509) of E. faecium isolates; 131 E. faecium isolates exhibited typical VanA phenotypes (group vanA-VanA), while the remaining 48 E. faecium isolates exhibited atypical phenotypes (group vanA-atypical), which included VanD (n = 43) and vancomycin-variable phenotypes (n = 5). A multivariable logistic regression indicated that vanA positivity of causative pathogens was independently associated with the increased 30-day mortality rate in the patients with E. faecium BSI; however, there was no significant difference in survival rates between the patients of the vanA-VanA and vanA-atypical groups (log rank test, P = 0.904). A high 30-day mortality rate was observed in patients with vanA-positive E. faecium BSIs, and vanA positivity of causative E. faecium isolates was an independent risk factor for early mortality irrespective of the susceptibility phenotypes to glycopeptides; thus, intensified antimicrobial stewardship is needed to improve the clinical outcomes of patients with vanA-positive E. faecium BSI.

Download Full-text

Clinical Outcomes of Very Elderly Patients With Acute Hospitalization for Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.06.401 ◽

2010 ◽

Vol 16 (8) ◽

pp. S114

Author(s):

Richard S. Schofield ◽

Shawn D. Anderson ◽

Lynnette Boyer ◽

Carsten M. Schmalfuss ◽

Tamarah J. Jungklaus ◽

...

Keyword(s):

Heart Failure ◽

Elderly Patients ◽

Clinical Outcomes ◽

Very Elderly ◽

Acute Hospitalization

Download Full-text

Mortality and Prognostic Prediction in Very Elderly Patients With Severe Pneumonia

Journal of Intensive Care Medicine ◽

10.1177/0885066619826045 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1405-1410 ◽

Cited By ~ 2

Author(s):

Moon Seong Baek ◽

Sojung Park ◽

Jeong-Hee Choi ◽

Cheol-Hong Kim ◽

In Gyu Hyun

Keyword(s):

Elderly Patients ◽

Hospital Mortality ◽

Pneumonia Severity Index ◽

Nursing Home Residents ◽

Area Under The Curve ◽

Severe Pneumonia ◽

Operating Characteristics ◽

Very Elderly ◽

Pneumonia Severity ◽

Prognostic Prediction

Introduction: Although prognostic prediction scores for pneumonia such as CURB-65 score or pneumonia severity index (PSI) are widely used, there were a few studies in very elderly patients. The aim of the study was to validate prognostic prediction scores for severe pneumonia and investigate risk factors associated with in-hospital mortality of severe pneumonia in very elderly patients. Methods: During the 6-year study period (from October 2012 to May 2018), 160 patients aged 80 or older admitted to medical intensive unit were analyzed retrospectively. Pneumonia severity was evaluated using CURB-65 score, PSI, Sequential Organ Failure Assessment (SOFA) scores, A-DROP, I-ROAD, UBMo index, SOAR score, and lactate. The outcome was in-hospital mortality. Results: The median age was 85 years (interquartile range: 82-88). Nursing home residents accounted for 71 (44.4%) and in-hospital mortality was 40 (25.0%). Logistic regression showed that chronic lung, mechanical ventilation, hemodialysis, and albumin were associated with in-hospital mortality of pneumonia. Using the receiver operating characteristics curve for predicting mortality, the area under the curve in pneumonia was 0.65 for the SOFA score, 0.61 for the CURB-65 score, 0.52 for the PSI, 0.58 for the A-DROP, 0.52 for the I-ROAD, 0.54 for UBMo index, 0.59 for SOAR score, and 0.65 for lactate. Conclusion: The performances of the CURB-65 and PSI are not excellent in very elderly patients with pneumonia. Further studies are needed to improve the performance of prognostic prediction scores in elderly patients.

Download Full-text

Melphalan-Prednisone-Thalidomide (MP-T) Demonstrates a Significant Survival Advantage in Elderly Patients ≥75 Years with Multiple Myeloma Compared with Melphalan-Prednisone (MP) in a Randomized, Double-Blind, Placebo-Controlled Trial, IFM 01/01.

Blood ◽

10.1182/blood.v110.11.75.75 ◽

2007 ◽

Vol 110 (11) ◽

pp. 75-75 ◽

Cited By ~ 38

Author(s):

Cyrille Hulin ◽

Thierry Facon ◽

Philippe Rodon ◽

Brigitte Pegourie ◽

Lotfi Benboubker ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Partial Response ◽

Elderly Patients ◽

Controlled Trial ◽

Response To Treatment ◽

Rank Test ◽

Newly Diagnosed ◽

Very Elderly ◽

Double Blind ◽

Vte Prophylaxis

Abstract Background: The MP-T combination has become the standard treatment for newly diagnosed MM patients (pts) aged 65 to 75 years (Facon et al; Lancet 2007 [Epub ahead of print]). However, no specific therapeutic recommendation exists for pts ≥75 years regarding the benefit of adding thalidomide to MP. Patients older than 75 years have frequently been excluded from large clinical trials, although they represent more than 20% of MM pts. Methods: The IFM 01-01 trial was initiated in 4/2002. Pts ≥75 years with untreated MM were randomized to receive MP-placebo (M [0.2mg/kg/d] + P [2 mg/kg/d day1–4]) x 12 courses every 6-weeks + placebo) or MP-T (MP + daily thalidomide [100mg/d]). No anti-VTE prophylaxis was given. The primary end-point was overall survival (OS). Secondary end points were progression-free survival (PFS), response to treatment, and toxicity. Trial enrollment was prospectively planned for 258 patients. Two interim analyses were performed after inclusion of 150 and 200 patients. The IFM board decided to stop enrollment after the second interim analysis. Results: In all, 232 pts were randomized and 3 failed to meet inclusion criteria. In all, 229 pts were analyzed (113 MP-T; 116 MP-placebo) with a median age of 78.5 years (36% ≥80years). No differences between the 2 groups for baseline characteristics were observed except for gender (p=0.03). Data were analysed on an intent-to-treat basis. The median follow-up time was 24 months. The median OS time (se) was 45.3 (1.6) months with MP-T vs 27.7 (2.1) months with MP-placebo, the benefit was significant (p=0.03 log-rank test). The median PFS time (se) was 24.1 (2) months with MP-T vs 19 (1.4) months with MP-placebo (p=0.001). Rates of at least partial response, very good partial response and complete response were 62%, 22% and 7% with MP-T vs 31%, 7% and 1% with MP-placebo, respectively (p<0.001). In the MP-T arm, 42% of pts stopped treatment due to toxicity vs 11% in the MP-placebo arm. The major reasons in the MP-T arm were peripheral neuropathy (12/48), neutropenia (7/48), and DVT (7/48). Some toxicities (Grade 2–4) were significantly increased with MP-T: peripheral neuropathy (20% vs 5%), neutropenia (23% vs 9%) depression (7% vs 2%). There were no significative differences in DVT rates for MP-T (6%) vs MP-placebo (4%) or somnolence (6% vs 3%, respectively). After relapse in the MP-placebo arm, 77% of patients received Thalidomide. Survival time after progression was similar in the 2 groups, 9.8 months after MP-placebo and 9.3 months after MP-T. Conclusion: These results confirm the superiority of MP-T over MP for prolonging OS in elderly patients with newly diagnosed MM. The toxicity was acceptable in this very elderly population ≥ 75 years. A new era of progress is opened for these very elderly patients.

Download Full-text