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

Abstract

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.

Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry

“…In line with our results, a previous study found that disability was addictive to age ≥ 80 years in characterizing prognosis of older seniors hospitalized for SARS-CoV-2 infection. In particular, the group with older age and functional dependency showed a mortality risk 10 times higher than their counterparts [ 24 ]. In another experience involving ≥ 75 years patients, pre-infection disability and frailty significantly improved the accuracy of prognostic models, when added to clinical variables commonly used for younger individuals [ 25 ].…”

Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIR-I, and SII) on admission predicts in-hospital mortality in non-elderly and elderly COVID-19 patients

“…Symptoms of coronavirus disease 2019 (COVID- 19) in patients are reported to vary from minor symptoms (such as headache, fatigue, and fever) to severe symptoms (such as dyspnea or hypoxia) (1)(2)(3)(4). With this wide range of clinical characteristics and disease outcomes, differences between nonelderly and old patients have also been reported (1,(5)(6)(7).…”

Prognostic Roles of Inflammation- and Nutrition-Based Indicators for Female Patients with Cancer

“… 41 Due to the reduction of nutritional intake caused by a decreased appetite and the increase in nutritional consumption caused by systemic inflammation, the nutritional statuses of elderly females are worse than those of young and middle-aged females. 16 , 43 We show that elderly females have the highest inflammatory load and the lowest nutritional status. Indicators of inflammatory and nutritional status were the most appropriate prognostic factors for elderly female patients.…”