Importance The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. Objective The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. Design, participants and locations This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. Results Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. Conclusions This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease.

To the Editor: Age-specific normal limits for a number of vital signs and physiological parameters have not been established in the elderly population. The limits for younger adults are not always applicable because of ageassociated physiological changes and the increase of interindividual differences with age. 1 Regarding the respiratory system, there are few data on normal respiratory rate at rest (RR) and peripheral pulse oximetry values (SpO 2 ), which are major parameters in clinical practice and easy to measure, and become altered quickly in respiratory and cardiac diseases. (Increased respiratory rate is often the only visible sign of a respiratory infection.) 2,3 This was a cross-sectional study of 791 noninstitutionalized individuals aged 65 and older living in Spain to establish the limits of normal RR and SpO 2 in the elderly population.The sample was collected using multistaged probabilistic sampling and stratified according to sex, size of place of residence (rural, urban, or big city), and geographic location with a nonproportional age stratum (523 subjects aged ≥80). A sample of 576 participants was considered necessary to estimate RR and SpO 2 with 5% error and a design effect of 1.5.Survey data were collected between 2007 and 2009. The survey was carefully designed to reduce nonsampling errors, the survey takers received specific training, and the field work was thoroughly supervised.RR and the SpO 2 were measured with the participant in a seated position after a rest of at least 10 minutes. SpO 2 was measured using a pulse oximeter (9500; Nonin Medical, Plymouth, MN), and RR was measured by directly observing thoracic movements for a 30-second period. As a distraction maneuver, the survey takers pretended to measure the radial pulse, so that participants would not be aware that their respiratory rate was being measured. 3 All information about participants' medical background was collected as control variables.Two consecutive analyses were conducted. First, all participants with pathologies that proved to affect RR or SpO 2 independently in multivariable models were excluded. A subsequent more-restricted analysis was performed by excluding all individuals who had any clinical factor showing significant influence in bivariate analyses. Participants with dyspnea during the examination were excluded from all calculations.Normal RR limits were represented according to percentiles that delimit 95% of the sample (2.5-97.5) and percentiles that delimit 99% of the sample (0.5-99.5). Limits of SpO 2 were represented according to the first and fifth percentiles. Calculations were weighted according to age, sex, and size of place of residence.History of chronic obstructive pulmonary disease (COPD) was the only variable that independently influenced RR and SpO 2 in the multivariate models. Once individuals with COPD were excluded, the RR distribution appeared bell-shaped, with 0.67 kurtosis and 0.43 asymmetry, and was significantly different from the theoretical normal distribution according to the Kolmogor...

BackgroundPatients with severe idiopathic Parkinson’s disease experience motor fluctuations, which are often difficult to control. Accurate mapping of such motor fluctuations could help improve patients’ treatment.ObjectiveThe objective of the study was to focus on developing and validating an automatic detector of motor fluctuations. The device is small, wearable, and detects the motor phase while the patients walk in their daily activities.MethodsAlgorithms for detection of motor fluctuations were developed on the basis of experimental data from 20 patients who were asked to wear the detector while performing different daily life activities, both in controlled (laboratory) and noncontrolled environments. Patients with motor fluctuations completed the experimental protocol twice: (1) once in the ON, and (2) once in the OFF phase. The validity of the algorithms was tested on 15 different patients who were asked to wear the detector for several hours while performing daily activities in their habitual environments. In order to assess the validity of detector measurements, the results of the algorithms were compared with data collected by trained observers who were accompanying the patients all the time.ResultsThe motor fluctuation detector showed a mean sensitivity of 0.96 (median 1; interquartile range, IQR, 0.93-1) and specificity of 0.94 (median 0.96; IQR, 0.90-1).ConclusionsON/OFF motor fluctuations in Parkinson's patients can be detected with a single sensor, which can be worn in everyday life.

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Association between spatial gait parameters and adverse health outcomes in the elderly has not been sufficiently studied. The goal of this study is to evaluate whether the stride length or the step width predict falls, functional loss and mortality. We conducted a prospective cohort study on a probabilistic sample of 431 noninstitutionalized, older-than-64-years subjects living in Spain, who were followed-up for five years. In the baseline visit, spatial gait parameters were recorded along with several control variables, with special emphasis on known medical conditions, strength, balance and functional and cognitive capacities. In the follow-up calls, vital status, functional status and number of falls from last control were recorded. We found that a normalized-to-height stride length shorter than 0.52 predicted recurrent falls in the next 6 months with 93% sensitivity and 53% specificity (AUC: 0.72), and in the next 12 months with 81% sensitivity and 57% specificity (AUC: 0.67). A normalized stride length <0.5 predicted functional loss at 12 months with a sensitivity of 79.4% and specificity of 65.6% (AUC: 0.75). This predictive capacity remained independent after correcting for the rest of risk factors studied. Step-with was not clearly related to functional loss or falls. Both shorter normalized stride length (OR1.56; AUC: 0.62; p < 0.05) and larger step width (OR1.42; AUC: 0.62; p < 0.05) were associated with risk of death at 60 months; however, none of them remained as independent predictor of death, after correcting for other risk factors. In summary, spatial gait parameters may be risk markers for adverse outcomes in the elderly. Step length is independently associated with functional loss and falls at one year, after correction for numerous known risk factors.

on behalf of the COVID-19 research group of CSAPG ¶

IntroductionOlder adults’ perception of their own risk of fall has never been included into screening tools. The goal of this study was to evaluate the predictive validity of questions on subjects’ self-perception of their own risk of fall.MethodsThis prospective study was conducted on a probabilistic sample of 772 Spanish community-dwelling older adults, who were followed-up for a one year period. At a baseline visit, subjects were asked about their recent history of falls (question 1: “Have you fallen in the last 6 months?”), as well as on their perception of their own risk of fall by using two questions (question 2: “Do you think you may fall in the next few months?” possible answers: yes/no; question 3: “What is the probability that you fall in the next few months?” possible answers: low/intermediate/high). The follow-up consisted of quarterly telephone calls, where the number of falls occurred in that period was recorded.ResultsA short questionnaire built with questions 1 and 3 showed 70% sensitivity (95% CI: 56%-84%), 72% specificity (95% CI: 68%-76%) and 0.74 area under the ROC curve (95% CI: 0.66–0.82) for prediction of repeated falls in the subsequent year.ConclusionsThe estimation of one’s own risk of fall has predictive validity for the occurrence of repeated falls in older adults. A short questionnaire including a question on perception of one’s own risk of fall and a question on the recent history of falls had good predictive validity.

<b><i>Introduction:</i></b> The oldest-old population (80 years or older) has the highest lethality from COVID-19. There is little information on the clinical presentation and specific prognostic factors for this group. This trial evaluated the clinical presentation and prognostic factors of severe disease and mortality in the oldest-old population. <b><i>Methods:</i></b> This is an ambispective cohort study of oldest-old patients hospitalized for respiratory infection associated with COVID-19 and with a positive test by RT-PCR. The clinical presentation and the factors associated with severe disease and mortality were evaluated (logistic regression). All patients were followed up until discharge or death. <b><i>Results:</i></b> A total of 103 patients (59.2% female) were included. The most frequent symptoms were fever (68.9%), dyspnoea (60.2%), and cough (39.8%), and 11.7% presented confusion. Fifty-nine patients (57.3%) presented severe disease, and 59 died, with 43 patients (41.7%) presenting both of these. In the multivariate analysis, female sex (odds ratio [OR] 0.31, 95% confidence interval [95% CI] 0.13–0.73, <i>p</i> 0.0074) and serum lactate dehydrogenase (LDH) (OR 2.55, 95% CI 1.21–5.37, <i>p</i> 0.0139) were associated with severe disease, and serum sodium was associated with mortality (OR 3.12, 95% CI 1.18–8.26, <i>p</i> 0.0222). No chronic disease or pharmacological treatment was associated with worse outcomes. <b><i>Conclusions:</i></b> The typical presenting symptoms of respiratory infection in COVID-19 are less frequent in the oldest-old population. Male sex and LDH level are associated with severe disease, and the serum sodium level is associated with mortality in this population.