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Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection

Introduction: Older adults are more susceptible to severe COVID-19, with increased all-cause mortality. This has been attributed to their multimorbidity and disability. However, it remains to be established which clinical features of older adults are associated with severe COVID-19 and mortality. Th...

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Autores principales: Mahmoud, Mona, Carmisciano, Luca, Tagliafico, Luca, Muzyka, Mariya, Rosa, Gianmarco, Signori, Alessio, Bassetti, Matteo, Nencioni, Alessio, Monacelli, Fiammetta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486012/
https://www.ncbi.nlm.nih.gov/pubmed/34604262
http://dx.doi.org/10.3389/fmed.2021.726837
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author Mahmoud, Mona
Carmisciano, Luca
Tagliafico, Luca
Muzyka, Mariya
Rosa, Gianmarco
Signori, Alessio
Bassetti, Matteo
Nencioni, Alessio
Monacelli, Fiammetta
author_facet Mahmoud, Mona
Carmisciano, Luca
Tagliafico, Luca
Muzyka, Mariya
Rosa, Gianmarco
Signori, Alessio
Bassetti, Matteo
Nencioni, Alessio
Monacelli, Fiammetta
author_sort Mahmoud, Mona
collection PubMed
description Introduction: Older adults are more susceptible to severe COVID-19, with increased all-cause mortality. This has been attributed to their multimorbidity and disability. However, it remains to be established which clinical features of older adults are associated with severe COVID-19 and mortality. This information would aid in an accurate prognosis and appropriate care planning. Here, we aimed to identify the chronic clinical conditions and the comorbidity clusters associated with in-hospital mortality in a cohort of older COVID-19 patients who were admitted to the IRCCS Policlinico San Martino Hospital, Genoa, Italy, between January and April 2020. Methods: This was a retrospective cohort study including 219 consecutive patients aged 70 years or older and is part of the GECOVID-19 study group. During the study period, upon hospital admission, demographic information (age, sex) and underlying chronic medical conditions (multimorbidity) were recorded from the medical records at the time of COVID-19 diagnosis before any antiviral or antibiotic treatment was administered. The primary outcome measure was in-hospital mortality. Results: The vast majority of the patients (90%) were >80 years; the mean patient age was 83 ± 6.2 years, and 57.5% were men. Hypertension and cardiovascular disease, along with dementia, cerebrovascular diseases, and vascular diseases were the most prevalent clinical conditions. Multimorbidity was assessed with the Cumulative Illness Rating Scale. The risk of in-hospital mortality due to COVID-19 was higher for males, for older patients, and for patients with dementia or cerebral-vascular disease. We clustered patients into three groups based on their comorbidity pattern: the Metabolic-renal-cancer cluster, the Neurocognitive cluster and the Unspecified cluster. The Neurocognitive and Metabolic-renal-cancer clusters had a higher mortality compared with the Unspecified cluster, independent of age and sex. Conclusion: We defined patterns of comorbidity that accurately identified older adults who are at higher risk of death from COVID-19. These associations were independent of chronological age, and we suggest that the identification of comorbidity clusters that have a common pathophysiology may aid in the early assessment of COVID-19 patients with frailty to promote timely interventions that, in turn, may result in a significantly improved prognosis.
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spelling pubmed-84860122021-10-02 Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection Mahmoud, Mona Carmisciano, Luca Tagliafico, Luca Muzyka, Mariya Rosa, Gianmarco Signori, Alessio Bassetti, Matteo Nencioni, Alessio Monacelli, Fiammetta Front Med (Lausanne) Medicine Introduction: Older adults are more susceptible to severe COVID-19, with increased all-cause mortality. This has been attributed to their multimorbidity and disability. However, it remains to be established which clinical features of older adults are associated with severe COVID-19 and mortality. This information would aid in an accurate prognosis and appropriate care planning. Here, we aimed to identify the chronic clinical conditions and the comorbidity clusters associated with in-hospital mortality in a cohort of older COVID-19 patients who were admitted to the IRCCS Policlinico San Martino Hospital, Genoa, Italy, between January and April 2020. Methods: This was a retrospective cohort study including 219 consecutive patients aged 70 years or older and is part of the GECOVID-19 study group. During the study period, upon hospital admission, demographic information (age, sex) and underlying chronic medical conditions (multimorbidity) were recorded from the medical records at the time of COVID-19 diagnosis before any antiviral or antibiotic treatment was administered. The primary outcome measure was in-hospital mortality. Results: The vast majority of the patients (90%) were >80 years; the mean patient age was 83 ± 6.2 years, and 57.5% were men. Hypertension and cardiovascular disease, along with dementia, cerebrovascular diseases, and vascular diseases were the most prevalent clinical conditions. Multimorbidity was assessed with the Cumulative Illness Rating Scale. The risk of in-hospital mortality due to COVID-19 was higher for males, for older patients, and for patients with dementia or cerebral-vascular disease. We clustered patients into three groups based on their comorbidity pattern: the Metabolic-renal-cancer cluster, the Neurocognitive cluster and the Unspecified cluster. The Neurocognitive and Metabolic-renal-cancer clusters had a higher mortality compared with the Unspecified cluster, independent of age and sex. Conclusion: We defined patterns of comorbidity that accurately identified older adults who are at higher risk of death from COVID-19. These associations were independent of chronological age, and we suggest that the identification of comorbidity clusters that have a common pathophysiology may aid in the early assessment of COVID-19 patients with frailty to promote timely interventions that, in turn, may result in a significantly improved prognosis. Frontiers Media S.A. 2021-09-17 /pmc/articles/PMC8486012/ /pubmed/34604262 http://dx.doi.org/10.3389/fmed.2021.726837 Text en Copyright © 2021 Mahmoud, Carmisciano, Tagliafico, Muzyka, Rosa, Signori, Bassetti, Nencioni, Monacelli and the GECOVID Study Group. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Mahmoud, Mona
Carmisciano, Luca
Tagliafico, Luca
Muzyka, Mariya
Rosa, Gianmarco
Signori, Alessio
Bassetti, Matteo
Nencioni, Alessio
Monacelli, Fiammetta
Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title_full Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title_fullStr Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title_full_unstemmed Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title_short Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection
title_sort patterns of comorbidity and in-hospital mortality in older patients with covid-19 infection
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486012/
https://www.ncbi.nlm.nih.gov/pubmed/34604262
http://dx.doi.org/10.3389/fmed.2021.726837
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