Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status

Laosa, Olga; Pedraza, Laura; Álvarez‐Bustos, Alejandro; Carnicero, José Antonio Carranza; Rodríguez‐Artalejo, Fernando; Rodríguez‐Mañas, Leocadio

doi:10.1016/j.jamda.2020.10.002

Cited by 26 publications

(53 citation statements)

References 26 publications

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“…It is arguable that the overall reduced physical fitness associated to older age could play a significant role for death risk. Similarly, other conditions that reduce overall physical fitness, as expressed by impairment in ADL and low Barthel index, were already found to be associated to an increased hazard for death in COVID-19 patients ( Laosa et al 2020 ; Heras et al 2020 ). Nevertheless, no final clues are available to explain why COVID-19 is disproportionately killing older people( Mueller, McNamara, & Sinclair 2020 ; Blagosklonny, 2020 ).…”

Section: Discussionmentioning

confidence: 84%

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

Covino

Matteis

Polla

et al. 2021

Archives of Gerontology and Geriatrics

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Introduction : To date, mainly due to age-related vulnerability and to coexisting comorbidities, older patients often face a more severe COVID-19. This study aimed to identify at Emergency Department (ED) admission the predictors of in-hospital mortality and suitable scores for death risk stratification among COVID-19 patients ≥ 80 years old. Methods : Single-centre prospective study conducted in the ED of an university hospital, referral center for COVID-19 in central Italy. We included 239 consecutive patients ≥ 80 years old with laboratory-confirmed COVID-19. The primary study endpoint was all-cause in-hospital mortality. Multivariable Cox regression analysis was performed on significant variables at univariate analysis to identify independent risk factor for death. Overall performance in predicting mortality of WHO severity scale, APACHE II score, NEWS score, and CURB-65 was calculated. Results : Median age was 85 [82-89] and 112 were males (46.9%). Globally, 77 patients (32.2%) deceased. The presence of consolidations at chest x-ray and the hypoxemic respiratory failure were significant predictors of poor prognosis. Moreover, age ≥ 85 years, dependency in activities of daily living (ADL), and dementia were risk factors for death, even after adjusting for clinical covariates and disease severity. All the evaluated scores showed a fairly good predictive value in identifying patients who could experience a worse outcome. Conclusions : Among patients ≥ 80 years old hospitalized with COVID-19, not only a worse clinical and radiological presentation of the disease, but also the increasing age, dementia, and impairment in ADL were strong risk factors for in-hospital death, regardless of disease severity.

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Section: Discussionmentioning

confidence: 84%

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

Covino

Matteis

Polla

et al. 2021

Archives of Gerontology and Geriatrics

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“…A few studies on older patients with COVID-19 have been reported associations of frailty [8,9] and functional status [11,12] with increased risk of mortality. We chose the Katz Index of Independence in ADL to investigate the prognostic significance of functional status, due to its simplicity and effectiveness in measuring functional ability [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…In another study, comprising 108 older inpatients aged ≥ 65 years with COVID-19, functional disability was also assessed by the Katz Index and its score ≤ 5 points was strongly associated with one-month mortality [11]. Elsewhere, among 375 patients hospitalized for COVID-19, mean age 66 years, functional status was evaluated by the Barthel index, using a 100-point score [12]. Each 5-point decrement in the Barthel score was associated with a 13 % increased risk of in-hospital death.…”

Section: Discussionmentioning

confidence: 99%

“…The cohort was stratified according to age ≥ 80 years; the rationale for this cut-off was its selection in other relevant studies [2,8,12]. Functional status prior to admission was evaluated by the Katz Index of Independence in Activities of Daily Living (ADL) [13,14].…”

Section: Study Population and Designmentioning

confidence: 99%

“…In studies focused on older patients with COVID-19, additional factors such as male sex, certain comorbid conditions and various laboratory abnormalities were associated with increased mortality, similar to younger patients [6][7][8][9]. However, in elderly patient populations, certain specific conditions, such as dementia [7,10], frailty [8,9] and functional status [11,12], have been reported to be associated with increased mortality risk.…”

Section: Introductionmentioning

confidence: 98%

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The prognostic role of functional dependency in older inpatients with COVID-19

et al. 2021

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Background Coronavirus disease 2019 (COVID-19) is a pandemic infection with substantial risk of death, especially in elderly persons. Information about the prognostic significance of functional status in older patients with COVID-19 is scarce. Methods Demographic, clinical, laboratory and short-term mortality data were collected of 186 consecutive patients aged ≥ 65 years hospitalized with COVID-19. The data were compared between 4 study groups: (1) age 65–79 years without severe functional dependency; (2) age ≥ 80 years without severe functional dependency; (3) age 65–79 years with severe functional dependency; and (4) age ≥ 80 years with severe functional dependency. Multivariate logistic regressions were performed to evaluate the variables that were most significantly associated with mortality in the entire sample. Results Statistically significant differences were observed between the groups in the proportions of males (p = 0.007); of patients with diabetes mellitus (p = 0.025), cerebrovascular disease (p < 0.001), renal failure (p = 0.003), dementia (p < 0.001), heart failure (p = 0.005), pressure sores (p < 0.001) and malignant disorders (p = 0.007); and of patients residing in nursing homes (p < 0.001). Compared to groups 1 (n = 69) and 2 (n = 28), patients in groups 3 (n = 32) and 4 (n = 57) presented with lower mean serum albumin levels on admission (p < 0.001), and were less often treated with convalescent plasma (p < 0.001), tocilizumab (p < 0.001) and remdesivir (p < 0.001). The overall mortality rate was 23.1 %. The mortality rate was higher in group 4 than in groups 1 − 3: 45.6 % vs. 8.7 %, 17.9% and 18.3 %, respectively (p < 0.001). On multivariate analysis, both age ≥ 80 years and severe functional dependency were among the variables most significantly associated with mortality in the entire cohort (odds ratio [OR] 4.83, 95 % confidence interval [CI] 1.88 − 12.40, p < 0.001 and OR 2.51, 95 % CI 1.02 − 6.15, p = 0.044, respectively). Age ≥ 80 years with severe functional dependency (group 4) remained one of the variables most significantly associated with mortality (OR 10.42, 95 % CI 3.27–33.24 and p < 0.001). Conclusions Among patients with COVID-19, the association of severe functional dependency with mortality is stronger among those aged ≥ 80 years than aged 65–79 years. Assessment of functional status may contribute to decision making for care of older inpatients with COVID-19.

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A rapid and feasible tool for clinical decision making in community-dwelling patients with COVID-19 and those admitted to emergency departments: the Braden-LDH-HorowITZ Assessment—BLITZ

Lagolio

Demurtas

Buzzetti³

et al. 2021

Intern Emerg Med

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There is no univocal standardized strategy to predict outcomes and stratify risk of SARS-CoV-2 infected patients, notably in emergency departments. Our aim is to develop an accurate indicator of adverse outcomes based on a retrospective analysis of a COVID-19 database established at the Emergency Department (ED) of a North-Italian hospital during the first wave of SARS-CoV-2 infection. Laboratory, clinical, psychosocial and functional characteristics including those obtained from the Braden Scale—a standardized scale to quantify the risk of pressure sores which takes into account aspects of sensory perception, activity, mobility and nutrition—from the records of 117 consecutive patients with swab-positive COVID-19 disease admitted to the Emergency Medicine ward between March 1, 2020 and April 15, 2020 were included in the analysis. Adverse outcomes included admission to the Intensive Care Unit (ICU) and in-hospital death. Among the parameters collected, the highest cutoff sensitivity and specificity scores to best predict adverse outcomes were displayed by lactate dehydrogenase (LDH) blood value at admission > 439 U/L, Horowitz Index (P/F Ratio) < 257 and Braden score < 18. The estimation power reached 93.6%. We named the assessment BLITZ (Braden-LDH-HorowITZ). Despite the retrospective and preliminary nature of the data, a multidimensional tool to assess overall functions, not chronological age, produced the highest prediction power for poor outcomes in relation to SARS-CoV-2 infection. Further analyses are now needed to establish meaningful correlations between ventilation therapies and multidimensional frailty as assessed by ad-hoc validated and standardized tools.

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Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status

Cited by 26 publications

References 26 publications

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

The prognostic role of functional dependency in older inpatients with COVID-19

A rapid and feasible tool for clinical decision making in community-dwelling patients with COVID-19 and those admitted to emergency departments: the Braden-LDH-HorowITZ Assessment—BLITZ

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