Factors affecting mortality in geriatric patients hospitalized with COVID-19

Factors affecting mortality in geriatric patients hospitalized with COVID-19

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19). Materials and methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death. Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107–20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473–14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012–1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000–1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001–1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126–1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811–0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065–0.874, P: 0.031). Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.Key words: COVID-19, geriatrics, hospitalized patients, mortality, risk factors

___

  • 1. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods in Molecular Biology 2015; 1282: 1-23. doi: 10.1007/978-1-4939-2438-7_1
  • 2. Su S, Wong G, Shi W, Liu J, Lai ACK et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends in Microbiology 2016; 24 (6): 490-502. doi: 10.1016/j. tim.2016.03.003
  • 3. Yi Y, Lagniton PNP, Ye S, Li E, Xu RH. COVID-19: what has been learned and to be learned about the novel coronavirus disease. International Journal of Biological Sciences 2020; 16 (10): 1753-1766. doi: 10.7150/ijbs.45134
  • 4. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, RodríguezMañas L et al. Physical frailty: ICFSR International Clinical Practice Guidelines for ıdentification and management. Journal of Nutrition, Health and Aging 2019; 23 (9): 771-787. doi: 10.1007/s12603-019-1273-z
  • 5. Landi F, Barillaro C, Bellieni A, Brandi V, Carfì A et al. The new challenge of geriatrics: saving frail older people from the SARS-COV-2 pandemic ınfection. Journal of Nutrition, Health and Aging 2020; 24 (5): 466-470. doi: 10.1007/s12603-020- 1356-x
  • 6. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
  • 7. Eubank S, Eckstrand I, Lewis B, Venkatramanan S, Marathe M et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Bulletin of Mathematical Biology 2020; 82 (4): 52. doi: 10.1007/s11538- 020-00726-x
  • 8. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH et al. Radiological Society of North America Expert consensus statement on reporting chest CT findings related to COVID-19: endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. Journal of Thoracic Imaging 2020; 35 (4): 219-227. doi: 10.1097/RTI.0000000000000524
  • 9. Lim WS, Van der Eerden MM, Laing R, Boersma WG, Karalus N et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58 (5): 377-82. doi: 10.1136/ thorax.58.5.377
  • 10. Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D et al. COVID-19 and older adults: what we know. Journal of American Geriatric Society 2020; 68 (5): 926-929. doi: 10.1111/ jgs.16472
  • 11. Wu Z, McGoogan JM. Characteristics of and ımportant lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a Report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Journal of the American Medical Association 2020; 323 (13): 1239-1242. doi: 10.1001/jama.2020.2648
  • 12. Sun H, Ning R, Tao Y, Yu C, Deng X et al. Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, China: a retrospective study. Journal of American Geriatric Society 2020; 68 (6): E19-E23. doi: 10.1111/jgs.16533
  • 13. Yu C, Lei Q, Li W, Wang X, Liu W et al. Clinical characteristics, associated factors, and predicting COVID-19 mortality risk: a retrospective study in Wuhan, China. American Journal of Preventive Medicine 2020; 59 (2): 168-175. doi: 10.1016/j. amepre.2020.05.002
  • 14. Meng Y, Lu W, Guo E, Liu J, Yang B et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. Journal of Hematology & Oncology 2020; 13 (1): 75. doi: 10.1186/s13045-020-00907-0
  • 15. Zhou P, Yang XL, Wang XG, Hu B, Zhang L et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579 (7798): 270-273. doi: 10.1038/s41586- 020-2012-7
  • 16. Rice GI, Thomas DA, Grant PJ, Turner AJ, Hooper NM. Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism. Biochemical Journal 2004; 383 (Pt 1): 45-51. doi: 10.1042/BJ20040634
  • 17. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P et al. Clinical presentation of COVID19 in dementia patients. Journal of Nutrition, Health and Aging 2020; 24 (6): 560-562. doi: 10.1007/s12603-020-1389-1
  • 18. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? a systematic review of definitions. BMC Geriatrics 2017; 17 (1): 230. doi: 10.1186/s12877-017-0621-2
  • 19. Huang C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506. doi: 10.1016/S0140- 6736(20)30183-5
  • 20. Huang H, Wan X, Bai Y, Bian J, Xiong J et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of T stages in hilar cholangiocarcinoma. Cancer Management and Research 2019; 11: 5157-5162. doi: 10.2147/CMAR.S192532
  • 21. Cataudella E, Giraffa CM, Di Marca S, Pulvirenti A, Alaimo S et al. Neutrophil-to-lymphocyte ratio: an emerging marker predicting prognosis in elderly adults with communityacquired pneumonia. Journal of American Geriatric Society 2017; 65 (8): 1796-1801. doi: 10.1111/jgs.14894
  • 22. Liu Y, Du X, Chen J, Jin Y, Peng L et al. Neutrophil-tolymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. Journal of Infection 2020; 81 (1): e6-e12. doi: 10.1016/j.jinf.2020.04.002
  • 23. Qin C, Zhou L, Hu Z, Zhang S, Yang S et al. Dysregulation of ımmune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clinical Infectious Diseases 2020; 71 (15): 762-768. doi: 10.1093/cid/ciaa248
  • 24. Wang K, Zuo P, Liu Y, Zhang M, Zhao X et al. Clinical and laboratory predictors of in-hospital mortality in patients with COVID-19: a cohort study in Wuhan, China. Clinical Infectious Diseases 2020: ciaa538. doi: 10.1093/cid/ciaa538
  • 25. Bousquet G, Falgarone G, Deutsch D, Derolez S, Lopez-Sublet M et al. ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19. Aging (Albany NY) 2020; 12 (12): 11306-11313. doi: 10.18632/aging.103583
  • 26. Marietta M, Coluccio V, Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Internal and Emergency Medicine 2020; 11: 1-13. doi: 10.1007/ s11739-020-02432-x
  • 27. Chiang CH, Shih JF, Su WJ, Perng RP. Eight-month prospective study of 14 patients with hospital-acquired severe acute respiratory syndrome. Mayo Clinic Proceedings 2004; 79 (11): 1372-1379. doi: 10.4065/79.11.1372
  • 28. Huang D, Lian X, Song F, Ma H, Lian Z et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Annals of Translational Medicine 2020; 8 (9): 576. doi: 10.21037/atm-20-2124
  • 29. Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. Journal of the American Medical Association 2020; 323 (24): 2493-2502. doi: 10.1001/ jama.2020.8630
  • 30. Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. Med 2020; 1 (1): 114-127. doi: 10.1016/j.medj.2020.06.001
  • 31. Retallack H, Di Lullo E, Arias C, Knopp KA, Laurie MT et al. Zika virus cell tropism in the developing human brain and inhibition by azithromycin. Proceedings of the National Academy of Sciences of the United States of America 2016; 113 (50): 14408-14413. doi: 10.1073/pnas.1618029113
  • 32. Madrid PB, Panchal RG, Warren TK, Shurtleff AC, Endsley AN et al. Evaluation of Ebola virus ınhibitors for drug repurposing. ACS Infectious Diseases 2015; 1 (7): 317-26. doi: 10.1021/ acsinfecdis.5b00030
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Nonsteroidal antiinflammatory drugs alter antibiotic susceptibility and expression of virulence-related genes and protein A of Staphylococcus aureus

Şafak ERMERTCAN, Yasemin ERAÇ, İsmail ÖZTÜRK, Petek BALLAR KIRMIZIBAYRAK

Evaluation of the results of patients who applied to the Çukurova University, Medical Genetics Department for prenatal diagnosis and determination of genetic counseling principles

Atıl BİŞGİN, Selim BÜYUKKURT, Sevcan TUĞ BOZDOĞAN, Sinem ÖZER

Basal and pentagastrin-stimulated calcitonin cut-off values in diagnosis of preoperative medullary thyroid cancer

Emine KARTAL BAYKAN, Mehmet ERDOĞAN

Evaluation of saliva glutathione, glutathione peroxidase, and malondialdehyde levels in head-neck radiotherapy patients

Hilal KIZILTUNÇ ÖZMEN, Nilgün AKGÜL, özde DERİNDAĞ, Hayati Murat AKGÜL, Ahmet KIZILTUNÇ, Halil İbrahim ÖZKAN

Reliability and validity of the Turkish version of the vestibular rehabilitation benefit questionnaire

Bülent GÜNDÜZ, Arzu GÜÇLÜ GÜNDÜZ, Yasemin APAYDIN, Burak KABİŞ

Retrospective analysis of the effect of breast surgery on body posture in patients with early-stage breast cancer after cancer treatment (VENUS study) (Breast cancer and body posture)

https://orcid.org/0000-0002-0598-7284, Ali ALKAN, Ozan Ahmet ÇETİN

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Muhammed Kürşat YELKEN, Ahmet Hakan BİRKENT, Haldun OĞUZ, Ozan Bağış ÖZGÜRSOY, Emel ÇADALLI TATAR, Zahide Çiler BÜYÜKATALAY, Necat ENVER, Kayhan ÖZTÜRK, Elad AZİZLİ, Sevtap AKBULUT, Hakan COŞKUN

Cutaneous adnexal tumors: the diagnostic role of dermatoscopic examination

Abdullah DEMİRBAŞ, Mustafa ATASOY, Ömer Faruk ELMAS, Ülker GÜL

Role of dyslipidemia in early vascular aging syndrome

Ziya APAYDIN, Alparslan KILIÇ, Onur BAYDAR, Deniz ELÇİK, Mehmet Mustafa CAN

Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus?

Özlem HALİLOĞLU, Özge POLAT KORKMAZ, Serdar ŞAHİN, Emre DURCAN, Zeynep OŞAR SİVA, Volkan Demirhan YUMUK, Hümeyra REKALI ŞAHİN, Taner DAMCI, Hasan İLKOVA