Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19
Background. The purpose of this study was to evaluate the prognostic impact of chest X-ray (CXR) score, frailty, and clinical and laboratory data on in-hospital mortality of hospitalized older patients with COVID-19. Methods. This retrospective study included 122 patients 65 years or older with posi...
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doaj-9e9e9989758d48ee95521db40a98242e2021-07-15T15:39:33ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-01102965296510.3390/jcm10132965Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19Sara Cecchini0Mirko Di Rosa1Luca Soraci2Alessia Fumagalli3Clementina Misuraca4Daniele Colombo5Iacopo Piomboni6Francesca Carnevali7Enrico Paci8Roberta Galeazzi9Piero Giordano10Massimiliano Fedecostante11Antonio Cherubini12Fabrizia Lattanzio13Department of Radiology, IRCCS INRCA, 60127 Ancona, ItalyUnit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, ItalyUnit of Geriatric Medicine, IRCSS INRCA, 87100 Cosenza, ItalyRespiratory Unit, IRCCS INRCA, 23880 Casatenovo, ItalyRespiratory Unit, IRCCS INRCA, 23880 Casatenovo, ItalyRespiratory Unit, IRCCS INRCA, 23880 Casatenovo, ItalyDepartment of Medicine and Health Sciences, University of Molise, 86100 Campobasso, ItalyDepartment of Radiology, IRCCS INRCA, 60127 Ancona, ItalyDepartment of Radiology, IRCCS INRCA, 60127 Ancona, ItalyLaboratory of Chemical-Clinical and Molecular Analysis, IRCCS INRCA, 60127 Ancona, ItalyInternal Medicine and Geriatrics, Hypertension Excellence Centre of the European Society of Hypertension, IRCCS INRCA, 60127 Ancona, ItalyGeriatria, Accettazione Geriatrica e Centro di Ricerca per L’invecchiamento, IRCCS INRCA, 60127 Ancona, ItalyGeriatria, Accettazione Geriatrica e Centro di Ricerca per L’invecchiamento, IRCCS INRCA, 60127 Ancona, ItalyScientific Direction, IRCCS INRCA, 60124 Ancona, ItalyBackground. The purpose of this study was to evaluate the prognostic impact of chest X-ray (CXR) score, frailty, and clinical and laboratory data on in-hospital mortality of hospitalized older patients with COVID-19. Methods. This retrospective study included 122 patients 65 years or older with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and with availability to CXRs on admission. The primary outcome of the study was in-hospital mortality. Statistical analysis was conducted using Cox regression. The predictive ability of the CXR score was compared with the Clinical Frailty Scale (CFS) and fever data using Area Under the Curve (AUC) and net reclassification improvement (NRI) statistics. Results. Of 122 patients, 67 died during hospital stay (54.9%). The CXR score (HR: 1.16, 95% CI, 1.04–1.28), CFS (HR: 1.27; 95% CI, 1.09–1.47), and presence of fever (HR: 1.75; 95% CI, 1.03–2.97) were significant predictors of in-hospital mortality. The addition of both the CFS and presence of fever to the CXR score significantly improved the prediction of in-hospital mortality (NRI, 0.460; 95% CI, 0.102 to 0.888; AUC difference: 0.117; 95% CI, 0.041 to 0.192, <i>p</i> = 0.003). Conclusions. CXR score, CFS, and presence of fever were the main predictors of in-hospital mortality in our cohort of hospitalized older patients with COVID-19. Adding frailty and presence of fever to the CXR score statistically improved predictive accuracy compared to single risk factors.https://www.mdpi.com/2077-0383/10/13/2965chest radiographic scoreCOVID-19 pneumoniafrailtyin-hospital mortality |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sara Cecchini Mirko Di Rosa Luca Soraci Alessia Fumagalli Clementina Misuraca Daniele Colombo Iacopo Piomboni Francesca Carnevali Enrico Paci Roberta Galeazzi Piero Giordano Massimiliano Fedecostante Antonio Cherubini Fabrizia Lattanzio |
spellingShingle |
Sara Cecchini Mirko Di Rosa Luca Soraci Alessia Fumagalli Clementina Misuraca Daniele Colombo Iacopo Piomboni Francesca Carnevali Enrico Paci Roberta Galeazzi Piero Giordano Massimiliano Fedecostante Antonio Cherubini Fabrizia Lattanzio Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 Journal of Clinical Medicine chest radiographic score COVID-19 pneumonia frailty in-hospital mortality |
author_facet |
Sara Cecchini Mirko Di Rosa Luca Soraci Alessia Fumagalli Clementina Misuraca Daniele Colombo Iacopo Piomboni Francesca Carnevali Enrico Paci Roberta Galeazzi Piero Giordano Massimiliano Fedecostante Antonio Cherubini Fabrizia Lattanzio |
author_sort |
Sara Cecchini |
title |
Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 |
title_short |
Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 |
title_full |
Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 |
title_fullStr |
Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 |
title_full_unstemmed |
Chest X-ray Score and Frailty as Predictors of In-Hospital Mortality in Older Adults with COVID-19 |
title_sort |
chest x-ray score and frailty as predictors of in-hospital mortality in older adults with covid-19 |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-07-01 |
description |
Background. The purpose of this study was to evaluate the prognostic impact of chest X-ray (CXR) score, frailty, and clinical and laboratory data on in-hospital mortality of hospitalized older patients with COVID-19. Methods. This retrospective study included 122 patients 65 years or older with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and with availability to CXRs on admission. The primary outcome of the study was in-hospital mortality. Statistical analysis was conducted using Cox regression. The predictive ability of the CXR score was compared with the Clinical Frailty Scale (CFS) and fever data using Area Under the Curve (AUC) and net reclassification improvement (NRI) statistics. Results. Of 122 patients, 67 died during hospital stay (54.9%). The CXR score (HR: 1.16, 95% CI, 1.04–1.28), CFS (HR: 1.27; 95% CI, 1.09–1.47), and presence of fever (HR: 1.75; 95% CI, 1.03–2.97) were significant predictors of in-hospital mortality. The addition of both the CFS and presence of fever to the CXR score significantly improved the prediction of in-hospital mortality (NRI, 0.460; 95% CI, 0.102 to 0.888; AUC difference: 0.117; 95% CI, 0.041 to 0.192, <i>p</i> = 0.003). Conclusions. CXR score, CFS, and presence of fever were the main predictors of in-hospital mortality in our cohort of hospitalized older patients with COVID-19. Adding frailty and presence of fever to the CXR score statistically improved predictive accuracy compared to single risk factors. |
topic |
chest radiographic score COVID-19 pneumonia frailty in-hospital mortality |
url |
https://www.mdpi.com/2077-0383/10/13/2965 |
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