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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Frontiers Media S.A.
2021-09-01
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Series: | Frontiers in Medicine |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.726837/full |
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doaj-72ee003a5fd74a56b70855e435700102 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mona Mahmoud Mona Mahmoud Luca Carmisciano Luca Tagliafico Luca Tagliafico Mariya Muzyka Mariya Muzyka Gianmarco Rosa Gianmarco Rosa Alessio Signori Matteo Bassetti Alessio Nencioni Alessio Nencioni Fiammetta Monacelli Fiammetta Monacelli The GECOVID Study Group |
spellingShingle |
Mona Mahmoud Mona Mahmoud Luca Carmisciano Luca Tagliafico Luca Tagliafico Mariya Muzyka Mariya Muzyka Gianmarco Rosa Gianmarco Rosa Alessio Signori Matteo Bassetti Alessio Nencioni Alessio Nencioni Fiammetta Monacelli Fiammetta Monacelli The GECOVID Study Group Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection Frontiers in Medicine COVID-19 infection cluster of comorbidity older adults mortality prognosis |
author_facet |
Mona Mahmoud Mona Mahmoud Luca Carmisciano Luca Tagliafico Luca Tagliafico Mariya Muzyka Mariya Muzyka Gianmarco Rosa Gianmarco Rosa Alessio Signori Matteo Bassetti Alessio Nencioni Alessio Nencioni Fiammetta Monacelli Fiammetta Monacelli The GECOVID Study Group |
author_sort |
Mona Mahmoud |
title |
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_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_sort |
patterns of comorbidity and in-hospital mortality in older patients with covid-19 infection |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-09-01 |
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. |
topic |
COVID-19 infection cluster of comorbidity older adults mortality prognosis |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2021.726837/full |
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doaj-72ee003a5fd74a56b70855e4357001022021-09-17T04:46:36ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-09-01810.3389/fmed.2021.726837726837Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 InfectionMona Mahmoud0Mona Mahmoud1Luca Carmisciano2Luca Tagliafico3Luca Tagliafico4Mariya Muzyka5Mariya Muzyka6Gianmarco Rosa7Gianmarco Rosa8Alessio Signori9Matteo Bassetti10Alessio Nencioni11Alessio Nencioni12Fiammetta Monacelli13Fiammetta Monacelli14The GECOVID Study GroupGeriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyDISSAL, Department of Health Science, University of Genoa, Genoa, ItalyGeriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyGeriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyCardiology Clinic, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, ItalyDISSAL, Department of Health Science, University of Genoa, Genoa, ItalyInfectious Diseases Clinic, Department of Health Sciences, University of Genoa and Policlinico San Martino Hospital, Genoa, ItalyGeriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyGeriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, ItalyIstituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino Hospital, Genoa, ItalyIntroduction: 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.https://www.frontiersin.org/articles/10.3389/fmed.2021.726837/fullCOVID-19 infectioncluster of comorbidityolder adultsmortalityprognosis |