Mortality risk factors in a Spanish cohort of oldest-old patients hospitalized with COVID-19 in an acute geriatric unit: the OCTA-COVID study

Abstract

The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19. To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Single-center observational study. Patients\u2009≥\u200975 years admitted to an Acute Geriatric Unit with COVID-19. Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Three hundred patients were consecutively included (62.7% females, mean age of 86.3\u2009±\u20096.6 years). Barthel Index (BI) was\u2009<\u200960 in 127 patients (42.8%) and 126 (42.0%) had Charlson Index CI\u2009≥\u20093. Most patients (216; 72.7%) were frail (Clinical Frailty Scale\u2009≥\u20095) and 134 patients (45.1%) had dementia of some degree. The overall in-hospital mortality rate was 37%. The following factors were associated with higher in-hospital mortality in a multi-variant analysis: CURB-65 score\u2009=\u20093–5 (HR 7.99, 95% CI 3.55–19.96, p\u2009<\u20090.001), incident delirium (HR 1.72, 1.10–2.70, p\u2009=\u20090.017) and dementia (HR 3.01, 95% CI 1.37–6.705, p\u2009=\u20090.017). Protective factors were concurrent use of angiotensin-converting enzyme inhibitors (HR 0.42, 95% CI 0.25–0.72, p\u2009=\u20090.002) or prescription of hydroxychloroquine (HC 0.37 95% CI 0.22–0.62, p\u2009<\u20090.001) treatment during admission. Our findings suggest that recognition of geriatric syndromes together with the CURB-65 score may be useful tools to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19.