key: cord-0993885-at0vq9su authors: Becerra-Muñoz, Víctor Manuel; Núñez-Gil, Iván J; Eid, Charbel Maroun; Aguado, Marcos García; Romero, Rodolfo; Huang, Jia; Mulet, Alba; Ugo, Fabrizio; Rametta, Francesco; Liebetrau, Christoph; Aparisi, Alvaro; Fernández-Rozas, Inmaculada; Viana-Llamas, María C; Feltes, Gisela; Pepe, Martino; Moreno-Rondón, Luis A; Cerrato, Enrico; Raposeiras-Roubín, Sergio; Alfonso, Emilio; Carrero-Fernández, Ana; Buzón-Martín, Luis; Abumayyaleh, Mohammad; Gonzalez, Adelina; Ortiz, Antonio Fernández; Macaya, Carlos; Estrada, Vicente; Fernández-Pérez, Cristina; Gómez-Doblas, Juan José title: Clinical profile and predictors of in-hospital mortality among older patients admitted for COVID-19 date: 2020-11-17 journal: Age Ageing DOI: 10.1093/ageing/afaa258 sha: 9d6a4c1580a568d621e22b860e838eb00c7788a7 doc_id: 993885 cord_uid: at0vq9su BACKGROUND: The coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients. METHODS: Post-hoc analysis of the international, multicentre, “real-world” HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65–74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality. RESULTS: 1,520 patients aged ≥65 years (60.3% male, median age of 76 [IQR 71–83] years) were included. Comorbidities such as hypertension (69.2%), dyslipidemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8,06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm(3)) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality. CONCLUSION: Patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population. COVID-19 is characterized by poor outcomes and mortality, especially among older patients. [2] In fact, from the beginning of the epidemic, older age has been identified as an important risk factor for disease severity, with increasing rates of mortality across every decade of life. [3] [4] [5] [6] This may be a consequence of poorer previous health status, with higher prevalence of preexisting comorbidities and a higher degree of frailty. [7] Whether worse quality of care in settings where healthcare systems were overwhelmed may also contributed to the observed poor prognosis is unclear. As older patients represent a vulnerable population, comprehensive data are needed in order to improve health care pathways in the context of the COVID-19 pandemic. Herein, our first objective was to provide a detailed description of clinical characteristics, initial symptoms and management of a cohort of 65 years or older individuals hospitalised for COVID-19. Furthermore, we aimed to present outcomes and to investigate predictors of in-hospital mortality in this highly susceptible population. Finally, we assessed the differences in terms of baseline characteristics, prognosis and treatment among patients Please see appendix 2. 1520 patients aged ≥65 years were included in the study (Appendix 1g). Hydroxychloroquine, antibiotics (e.g. Azithromycin) and antiviral drugs were frequently used (82. 2, 78.7 and 59.1%, respectively) . Almost 80% required oxygen during admission and 6.4% used mechanical ventilation. A detailed description can be found in Table 1 . A comparison between patients aged 65-74 and ≥75 years in terms of baseline characteristics, baseline medication, symptoms, in-hospital outcomes and therapies is shown in Almost all in-hospital complications were more frequent in patients older than 75 years ( Figure 1 ). However, admission to ICU was limited to 42 patients (11.2 vs. 4.8%) , and invasive mechanical ventilation was used in 4.4% of patients ≥75 years. Other commonly used treatments for COVID- 19, such as hydroxychloroquine, antiviral drugs, interferon and tocilizumab were prescribed less frequently to those aged 75 and over. All-cause mortality was 541 of 1520 participants (35.6%). A higher mortality across increasing age subgroups was found, from 11.7% in patients 65-69 years to 54.5% in patients above 80 years ( Figure 2 [11] In a more recent study that included 8910 patients from Asia, Europe and America, an age greater than 65 years was found to be independently associated with an increased risk of in-hospital death (mortality of 10.0%, vs. 4.9% among those ≤65 years of age). [12] In our cohort of older people with COVID-19, we found an increasing inhospital mortality across ages, from 11% in patients aged 65-69 to more than 50% in those aged 80 or older. Although this may seem an significantly higher rate of mortality than the previously mentioned studies, asymptomatic patients and those with mild degrees of the disease were not usually hospitalised and thus, they are not represented in our population of study. However, when comparing with reports of hospitalised patients from China, we also find differences in outcomes. For example, from a cohort of 1099 patients in the first two months of the outbreak, Guan et al reported 153 patients aged ≥65 with a presence of composite end-point (admission The presence of a higher number of comorbidities and a worse immune response towards the infection may be related to older patients´ susceptibility. [14] As in previous studies, we found a high prevalence of comorbidities within these patients admitted to hospital for COVID-19. Previous conditions such as cardiovascular diseases, diabetes mellitus, hypertension, chronic lung diseases, obesity, cancer and chronic kidney disease have been associated with severe illness and mortality. [5, 6, 12, [15] [16] [17] . In our study, chronic kidney disease (eGFR<30ml/min/1.73m2) was found to be an independent risk factor of mortality, with an OR 3.36. Kidney disease has been already described as a risk factor for mortality in COVID- Importantly, this is one of the few studies to associate dementia with worse [23] A very low level of lymphocytes was another independent predictor. It is known that the lymphocyte count decreases in COVID-19 patients. [24, 25] Potential mechanisms may be the lymphocytes death or dysfunction caused directly by the virus or indirectly through inflammatory cytokines or metabolic molecules. [26] In our study, other important predictors of mortality were a qSOFA scale more than 1 point and a peripheral oxygen saturation less than 92% at admission, parameters which reflect a more severe degree of the disease on arrival to the emergency room. Interestingly, patients 75 years and older were less frequently admitted to ICUs and received less therapies commonly used for COVID-19 treatment. Madrid, Spain). This nonprofit institution had no role in the study design; in the collection, analysis, interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication. World Health Organization. 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