Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain

Ramos-Rincon, Jose-Manuel; Buonaiuto, Verónica; Ricci, Michele; Martín-Carmona, Jesica; Paredes-Ruíz, Diana; Calderón-Moreno, María; Rubio-Rivas, Manel; Beato-Pérez, José-Luis; Arnalich-Fernández, Francisco; Monge-Monge, Daniel; Vargas-Núñez, Juan-Antonio; Acebes-Repiso, Gonzalo; Mendez-Bailon, Manuel; Perales-Fraile, Isabel; García-García, Gema-María; Guisado-Vasco, Pablo; Abdelhady-Kishta, Alaaeldeen; Pascual-Pérez, Maria-de-los-Reyes; Rodríguez-Fernández-Viagas, Cristina; Montaño-Martínez, Adrián; López-Ruiz, Antonio; Gonzalez-Juarez, Maria-Jesus; Pérez-García, Cristina; Casas-Rojo, José-Manuel; Gómez-Huelgas, Ricardo

BACKGROUND: Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. METHODS: We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1–May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. RESULTS: A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index < 60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n: 1301) and increased with age (80–84 years: 41.6%; 85–90 years: 47.3%; 90–94 years: 52.7%; ≥95 years: 54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: oxygen saturation < 90%; temperature ≥ 37.8°C; quick sequential organ failure assessment (qSOFA) score ≥ 2; and unilateral–bilateral infiltrates on chest x-rays. Some analytical findings were independent risk factors for death, including estimated glomerular filtration rate < 45 mL/min/1.73 m(2); lactate dehydrogenase ≥ 500 U/L; C-reactive protein ≥ 80 mg/L; neutrophils ≥ 7.5 × 10(3)/μL; lymphocytes < 0.8 × 10(3)/μL; and monocytes < 0.5 × 10(3)/μL. CONCLUSIONS: This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status—not comorbidities—are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.