Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

Lidou-Renault, Valentine; Baudouin, Édouard; Courtois-Amiot, Pauline; Bianco, Céline; Esnault, Hélène; Rouet, Audrey; Baque, Margaux; Toméo, Charlotte; Rainone, Antonio; Thietart, Sara; Veber, Romain; Ayache, Clementine; Pépin, Marion; Lafuente-Lafuente, Carmelo; Duron, Emmanuelle; Cailleaux, Pierre-Emmanuel; Haguenauer, Didier; Lemarié, Nadège; Paillaud, Éléna; Raynaud-Simon, A.; Thomas, Caroline; Boddaert, Jacques; Zerah, Lorène; Vallet, Hélène

doi:10.1093/gerona/glac084

Cited by 9 publications

(9 citation statements)

References 39 publications

(46 reference statements)

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“…However, few data were available for older patients. A French geriatric cohort found the use of corticosteroids significantly associated with in‐hospital mortality in older patients hospitalized for COVID‐19 (odds ratio [OR]: 2.24 [95% CI: 1.41–3.56]) 15 . Study of a European cohort showed corticosteroid treatment associated with increased risk of ICU mortality in older patients hospitalized with COVID‐19 (OR: 1.6 [1.26–2.04]) 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Study of a European cohort showed corticosteroid treatment associated with increased risk of ICU mortality in older patients hospitalized with COVID‐19 (OR: 1.6 [1.26–2.04]) 31 . The higher frequency of side effects in the geriatric population versus younger people and the immunosuppression induced by aging could explain the increased mortality in older patients receiving corticosteroids 15,31 . In addition, the advent of vaccination has considerably reduced mortality and the rate of admission to intensive care in older 32 …”

Section: Discussionmentioning

confidence: 99%

“…We selected studies including patients aged ≥70 years in eligibility criteria or as a separate age group clearly identified; including patients admitted to an ICU for proven COVID‐19; reporting data on outcome in terms of survival/mortality, among ICU mortality, 1‐month mortality and 3‐month mortality; published after December 2019; and reported in English. The cut‐off of 70 years old was chosen because most studies focusing on the geriatric patients hospitalized for COVID‐19 used this cut‐off 13–15 . We did not include studies reported as an abstract only as data are incompletely reported.…”

Section: Methodsmentioning

confidence: 99%

“…The cut-off of 70 years old was chosen because most studies focusing on the geriatric patients hospitalized for COVID-19 used this cut-off. [13][14][15] We did not include studies reported as an abstract only as data are incompletely reported.…”

Section: Eligibility Criteria Of Studiesmentioning

confidence: 99%

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Mortality in older patients admitted to an ICU for COVID‐19: A systematic review

Bianco

Guidet

Dechartres

et al. 2023

Acta Anaesthesiol Scand

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PurposeThe objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID‐19.Materials and MethodsData sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID‐19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist.ResultsWe selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1‐month mortality from 33% to 90% and 3‐month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1‐month and 3‐month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56–4.13] and HR: 2.83 [95% CI: 1.96–4.08]).ConclusionIn this systematic review of older patients admitted to an ICU with COVID‐19, we documented high heterogeneity of mortality rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Eligibility Criteria Of Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Mortality in older patients admitted to an ICU for COVID‐19: A systematic review

Bianco

Guidet

Dechartres

et al. 2023

Acta Anaesthesiol Scand

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“…The sub-group analysis of patients aged > 70 years in the RECOVERY trial has not found a signi cant decrease of 28-day mortality with glucocorticoid treatment, but it is possible that there was a lack of power in this subgroup [7]. In addition, a multicenter retrospective French cohort study in 15 acute COVID-19 geriatric wards during waves 1 to 3 (n = 1,579 patients) found that the use of glucocorticoids was associated with an increased in-hospital mortality [27]. Therefore, the bene t of glucocorticoids remains questionable, since it has still not been speci cally tested in the older population.…”

Section: Discussionmentioning

confidence: 99%

In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the Great Paris Area: A multicenter cohort study

Thietart

Rozes

Tubach

et al. 2022

Preprint

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Background Mortality is high in older patients hospitalized with COVID-19. Previous studies observed lower mortality during the Omicron wave, yet no data is available on older patients. The objective was to compare in-hospital mortality between the Omicron and previous waves in older patients hospitalized with COVID-19. Methods This retrospective observational multicenter cohort study used the Greater Paris University Hospitals Group’s data warehouse (38 hospitals). Patients aged ≥ 75 years with a confirmed COVID-19 diagnosis and hospitalized from March 2020 to January 2022 were included. The study period was divided into five waves. The fifth wave (January 1st to 31st 2022) was considered as the Omicron wave as it was the predominant variant (≥ 50%), and was compared with waves 1 (March-July 2020), 2 (August-December 2020), 3 (January-June 2021) and 4 (July-December 2021). Primary outcome was in-hospital mortality. Secondary outcome was occurrence of ICU admission or in-hospital death. Multivariate logistic regression was performed, with a sensitivity analysis according to variant type. Results Of the 195,084 patients hospitalized with COVID-19, 19,909 patients aged ≥ 75 years were included (median age 85 [IQR 79–90] years, 53% women). Overall in-hospital mortality was 4,337 (22%), reaching 345 (17%) during wave 5. Waves 1 and 3 were significantly associated with increased in-hospital mortality in comparison with wave 5 (adjusted Odds Ratios aOR 1.42 [95%CI 1.21–1.66] and 1.56 [95%CI 1.33–1.83] respectively). Waves 1 to 3 were associated with an increased risk of occurrence of ICU admission or in-hospital death in comparison with wave 5: aOR 1.29 [95% CI 1.12 to 1.49] for wave 1, aOR 1.25 [95% CI 1.08 to 1.45] for wave 2 and aOR 1.56 [95% CI 1.36 to 1.79] for wave 3. Sensitivity analysis found that Omicron variant was associated with decreased mortality, in comparison with previous variants. Conclusions Mortality was lower during the 5th Omicron wave in the older population, but remained high, implying that this variant could be considered as “milder” but not “mild”. This persistently high mortality during the 5th Omicron wave highlights the importance of including older patients in clinical trials to confirm the benefit/risk balance of COVID-19 treatments in this fragile population.

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Radiological lung sequelae, functional status and symptoms in older patients 3 and 6 months after hospitalization for COVID-19 pneumonia

et al. 2023

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The aim of our study was to assess the lung sequelae and clinical consequences 3 and 6 months after hospitalization for COVID-19 pneumonia in older patients. An observational study was conducted on 55 patients aged 65 years and older. Activities of daily living (ADL) and clinical frailty scale (CFS) were assessed at baseline and after 3 months. Both quantitative assessment at chest high-resolution computed tomography (CT) and semi-quantitative severity score (CTSS) were performed at baseline and after 3 and 6 months. Mean age: 82.3 ± 7.1 years. Male prevalence: 56.4%. After 6 months, ground-glass opacities (GGO) were still detectable in 22% of subjects, while consolidations were no longer appreciable. During follow-up, CTSS reached an overall median score of zero after 6 months. Fibrotic-like changes were found in 40% of subjects with an overall median score of 0 (0–5) points, being more prevalent in males. Patients reporting worsening ADL and CFS were 10.9% and 45.5%, respectively. They were associated with the burden of comorbidities, especially history of heart failure and chronic obstructive pulmonary disease at baseline. Amnesic disorders, exertional dyspnea, and fatigue were the most relevant symptoms reported. No association emerged between persistent or new-onset symptoms and evidence of fibrotic-like changes. The typical chest CT abnormalities of the COVID-19 pneumonia acute phase resolved in most of our older patients. Mild fibrotic-like changes persisted in less than half of the patients, especially males, without significantly affecting the functional status and frailty condition, which instead were more likely associated with pre-existing comorbidities.

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Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

Cited by 9 publications

References 39 publications

Mortality in older patients admitted to an ICU for COVID‐19: A systematic review

Mortality in older patients admitted to an ICU for COVID‐19: A systematic review

In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the Great Paris Area: A multicenter cohort study

Radiological lung sequelae, functional status and symptoms in older patients 3 and 6 months after hospitalization for COVID-19 pneumonia

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