Predictors for development of critical illness amongst older adults with COVID-19: Beyond age to age-associated factors

Yiğitbaş

Expert Review of Respiratory Medicine

et al. 2021

Background: Although COPD is not one of the most common comorbidities in COVID-19 patients, it can be more fatal in this group. This study aimed to investigate the characteristics and prognosis of COPD patients among the population with COVID-19. Research design and methods: Patients diagnosed with positive PCR test were included in our multicentered, retrospective study. Patients with airway obstruction (previous spirometry) were included in 'COPD group'. Results: The prevalence of COPD in COVID-19 patients was 4.96%(53/1069). There was a significant difference between COPD and non-COPD COVID-19 patients in terms of gender, mean age, presence of dyspnea, tachypnea, tachycardia, hypoxemia and presence of pneumonia. The mortality rate was 13.2% in COPD, 7% in non-COPD patients(p = 0.092). The significant predictors of mortality were higher age, lymphopenia (p < 0.001), hypoxemia (p = 0.028), high D-dimer level (p = 0.011), and presence of pneumonia (p = 0.043) in COVID-19 patients. Conclusions: Our research is one of the first studies investigating characteristics of COPD patients with COVID-19 in Turkey. Although COPD patients had some poor prognostic features, there was no statistical difference between overall survival rates of two groups. Age, status of oxygenization, serum D-dimer level, lymphocyte count and pneumonia were significantly associated parameters with mortality in COVID-19.

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of hospitalized COVID-19 patients with COPD

Yiğitbaş

Expert Review of Respiratory Medicine

et al. 2021

Journal of Health Sciences and Medicine

“…Figure 3 shows the rest of factors that are significantly associated with the non-survival status according to Table 3: CRP, sodium, WBC, and HGB (neutrophil and lymphocyte are combined into a ratio in Figure 2B and calcium in Figure 2D). All these plots show an interplay between these factors and age i.e., those non-surviving patients are predominately above certain old age; then, higher or lower level of these factors are, with various degrees, associated with the non-survival status (29). All these factors have been discussed in the COVID-19 literature: e.g., CRP, sodium and others, WBC, and HGB (30)(31)(32)(33).…”

Section: Direct Test Of Differences Between Three Groupsmentioning

confidence: 99%

COVID-19 outpatients and surviving inpatients exhibit comparable blood test results that are distinct from non-surviving inpatients

Ülgen

Çetin

Balci

et al. 2021

Aim:The decision of admitting COVID-19 patients as inpatients is mostly determined by chest X-ray based diagnosis of pneumonia severity. However, prognosis of inpatients may diverge into two groups, one group of inpatients did not survive while another group did.Material and Method: More than 100 COVID-19 outpatients are collected from Tokat, Turkey in three categories: outpatients, surviving inpatients, and deceased inpatients. Their blood test profiles are analyzed and compared by dimension reduction techniques and classic statistical tests. Results:We observe that surviving inpatients share a common blood test profile with the outpatients, whereas non-surviving inpatients are distinctively different. The non-surviving inpatients are on average older. Among patients older than certain age, non-surviving inpatients have higher neutrophil level, lower lymphocyte level (thus higher neutrophil/lymphocyte ratio), lower calcium level, higher C-reactive-protein, sodium, whole blood cell level, andlower hemoglobin level, than the surviving patients (whether these are inpatients or outpatients). Conclusion:Surviving status is more important than in-and out-patient status in a patient's cluster membership based on blood test profile. This result suggests a plan to use both X-ray diagnosis and blood test results as a criterion to admit COVID-19 inpatients.

“…This scale classifies the frailty severity into nine categories, where advanced categories are associated with a worse prognosis like hospitalizations or death [9], which were more evident in patients with COVID-19 [10]. Independently of the age, frailty has been linked with atypical presentations (functional decline, falls, delirium) [11] and in some cases with an increased in-hospital mortality, days of stay, intensive care unit (ICU) admission, and the need of support with mechanical ventilation [12,13]. This vulnerability is mainly associated with a type 1 interferon (IFN-1) altered response, impaired production of T and B cells, and a secretory phenotype of senescent cells (immunosenescence) [14,15], while considering that older people can be socially vulnerable [16].…”

Section: Introductionmentioning

confidence: 99%

Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations

Pizano-Escalante

Anaya-Esparza

Nuño

et al. 2021

JPM

Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19.