Age, Frailty, and Comorbidity as Prognostic Factors for Short-Term Outcomes in Patients With Coronavirus Disease 2019 in Geriatric Care
Age, Frailty, and Comorbidity as Prognostic Factors for Short-Term Outcomes in Patients With Coronavirus Disease 2019 in Geriatric Care
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DOI：
10.1016/j.jamda.2020.08.014
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发表时间：
2020-11-01
影响因子：
7.6
通讯作者：
Religa, Dorota
中科院分区：
文献类型：
--
作者：
Hagg, Sara;Jylhava, Juulia;Religa, Dorota
目的：分析虚弱和合并症是否与2019年因冠状病毒病住院的老年人的住院死亡率和出院回家相关（COVID-19）。设计：单中心观察性研究。设置和参与者：2020年3月1日至6月11日期间在瑞典一家大型医院接受老年护理的患者; 250人因COVID-19接受治疗，717人因其他诊断接受治疗。方法：COVID-19诊断是通过逆转录聚合酶链反应试验阳性或如果阴性，则通过其他方法临床确诊的。从电子病历中提取患者数据，其中包括临床虚弱量表（CFS），并进一步用于医院虚弱风险评分（HFRS）和Charlson合并症指数（CCI）的评估。住院死亡率和出院分别随访25天和28天。结果：在COVID-19患者中，住院死亡率为24%，出院率为44%。年龄越大，住院死亡率越高（每年的风险比[HR] 1.05，95%置信区间[CI] 1.01.1.08），出院回家的概率越低（HR 0.97，95% CI 0.95.0.99）。CFS（>5）和CCI（而非HFRS）可预测院内死亡率（HR 1.93，95%CI 1.02.3.65和HR 1.27，95%CI 1.02.1.58）。CFS >5的患者出院回家的概率较低（HR 0.38，95% CI 0.25.0.58）。CCI和HFRS与家庭出院无关。一般而言，对男性的影响更为明显。急性肾损伤与住院死亡率和出院回家后的高血压相关。其他合并症（糖尿病，心血管疾病，肺部疾病，慢性肾脏疾病和痴呆）与任何outcome.Conclusions和影响：在所有老年患者与COVID-19，在研究期间，4人中有3人存活。我们的研究结果表明，除了年龄外，虚弱程度是老年患者短期COVID-19结局的有用预测因素。(C)2020作者（S）爱思唯尔公司出版代表AMDA -急性后和长期护理医学协会。这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Objectives: To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19).Design: Single-center observational study.Setting and Participants: Patients admitted to geriatric care in a large hospital in Sweden between March 1 and June 11, 2020; 250 were treated for COVID-19 and 717 for other diagnoses.Methods: COVID-19 diagnosis was clinically confirmed by positive reverse transcription polymerase chain reaction test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used.Results: Among the patients with COVID-19, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR] 1.05 per each year, 95% confidence interval [CI] 1.01.1.08) and lower probability of home discharge (HR 0.97, 95% CI 0.95.0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR 1.93, 95% CI 1.02.3.65 and HR 1.27, 95% CI 1.02.1.58, respectively). Patients with CFS >5 had a lower probability of being discharged home (HR 0.38, 95% CI 0.25.0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome.Conclusions and Implications: Of all geriatric patients with COVID-19, 3 out of 4 survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).