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Tytuł:
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Age, Frailty, and Comorbidity as Prognostic Factors for Short-Term Outcomes in Patients With Coronavirus Disease 2019 in Geriatric Care.
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Autorzy:
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Hägg S; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: .
Jylhävä J; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Wang Y; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Xu H; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Metzner C; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
Annetorp M; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
Garcia-Ptacek S; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Khedri M; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
Boström AM; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden.
Kadir A; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Johansson A; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
Kivipelto M; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Eriksdotter M; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Cederholm T; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Religa D; Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
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Źródło:
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Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2020 Nov; Vol. 21 (11), pp. 1555-1559.e2. Date of Electronic Publication: 2020 Aug 14.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2005- : [New York?] : Elsevier
Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins, c2000-
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MeSH Terms:
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Comorbidity*
Frail Elderly*
Outcome Assessment, Health Care*
Coronavirus Infections/*diagnosis
Pneumonia, Viral/*diagnosis
Age Factors ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Female ; Geriatrics ; Humans ; Male ; Models, Statistical ; Pandemics ; Prognosis ; SARS-CoV-2 ; Survival Analysis ; Sweden
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References:
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Lancet. 2013 Mar 2;381(9868):752-62. (PMID: 23395245)
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Contributed Indexing:
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Keywords: COVID-19; aging; comorbidity; frailty; geriatrics; survival
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Entry Date(s):
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Date Created: 20200926 Date Completed: 20201120 Latest Revision: 20221003
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Update Code:
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20240105
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PubMed Central ID:
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PMC7427570
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DOI:
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10.1016/j.jamda.2020.08.014
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PMID:
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32978065
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Objectives: To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19).
Design: Single-center observational study.
Setting and Participants: Patients admitted to geriatric care in a large hospital in Sweden between March 1 and June 11, 2020; 250 were treated for COVID-19 and 717 for other diagnoses.
Methods: COVID-19 diagnosis was clinically confirmed by positive reverse transcription polymerase chain reaction test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used.
Results: Among the patients with COVID-19, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR] 1.05 per each year, 95% confidence interval [CI] 1.01‒1.08) and lower probability of home discharge (HR 0.97, 95% CI 0.95‒0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR 1.93, 95% CI 1.02‒3.65 and HR 1.27, 95% CI 1.02‒1.58, respectively). Patients with CFS >5 had a lower probability of being discharged home (HR 0.38, 95% CI 0.25‒0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome.
Conclusions and Implications: Of all geriatric patients with COVID-19, 3 out of 4 survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients.
(Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
