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Title: | Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain) |
Author: | Ramos Rincon, Jose Manuel Cobos Palacios, Lidia López Sampalo, Almudena Ricci, Michele Rubio Rivas, Manuel Nuñez Rodriguez, Maria Victoria Miranda Godoy, Rodrigo García Leoni, Maria Eugenia Fernández-Madera Martínez, Rosa García García, Gema María Beato Pérez, José Luis Monge Monge, Daniel Asín Samper, Uxua Bustamante Vega, Marta Rábago Lorite, Isabel Freire Castro, Santiago Jesús Miramontes González, Jose Pablo Magallanes Gamboa, Jeffrey Oskar Alcalá Pedrajas, José Nicolás García Gómez, Miriam Cano Llorente, Verónica Carrasco Sánchez, Francisco Martinez Carrilero, Jesús Antón Santos, Juan Miguel Gómez Huelgas, Ricardo SEMI-COVID-19 Network |
Keywords: | COVID-19 SARS-CoV-2 Mortalitat Epidemiologia Persones grans COVID-19 SARS-CoV-2 Mortality Epidemiology Older people |
Issue Date: | 30-Jun-2022 |
Publisher: | Springer Science and Business Media LLC |
Abstract: | Background: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. Methods This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients >= 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). Results Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were >= 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients >= 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79). Conclusions Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out. |
Note: | Reproducció del document publicat a: https://doi.org/10.1186/s12877-022-03191-4 |
It is part of: | BMC Geriatrics, 2022, vol. 22, num. 1, p. 546 |
URI: | http://hdl.handle.net/2445/187825 |
Related resource: | https://doi.org/10.1186/s12877-022-03191-4 |
ISSN: | 1471-2318 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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