Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. METHODS: This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). RESULTS: Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79). CONCLUSIONS: Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.
Source: BMC Geriatrics
Authors: Jose-Manuel Ramos-Rincon, Lidia Cobos-Palacios, Almudena López-Sampalo, Michele Ricci, Manel Rubio-Rivas, Maria-Victoria Nuñez-Rodriguez, Rodrigo Miranda-Godoy, Maria-Eugenia García-Leoni, Rosa Fernández-Madera-Martínez, Gema-María García-García, Jose-Luis Beato-Perez, Daniel Monge-Monge, Uxua Asín-Samper, Marta Bustamante-Vega, Isabel Rábago-Lorite, Santiago-Jesús Freire-Castro, Jose-Pablo Miramontes-González, Jeffrey-Oskar Magallanes-Gamboa, José-Nicolás Alcalá-Pedrajas, Miriam García-Gómez, Verónica Cano-Llorente, Francisco-Javier Carrasco-Sánchez, Jesús Martinez-Carrilero, Juan-Miguel Antón-Santos, Ricardo Gómez-Huelgas, the SEMI-COVID-19 Network
Institutions: Universitat de Miguel Hernández d'Elx, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Bellvitge University Hospital, Hospital Costa del Sol, Hospital Universitario 12 De Octubre, Hospital General Universitario Gregorio Marañón, Hospital Universitario De Cabueñes, Complejo Hospitalario Universitario de Albacete, Hospital General De Segovia, Hospital Universitario Miguel Servet, Hospital Universitario de La Princesa, Hospital Universitario Infanta Sofía, Complexo Hospitalario Universitario A Coruña, Hospital Universitario Río Hortega, Hospital General Nuestra Señora del Prado, Hospital Virgen de la Salud, Hospital Juan Ramón Jiménez, Hospital Universitario del Henares, Hospital Universitario Infanta Cristina, Instituto de Salud Carlos III, Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Centro de Investigación Biomédica en Red
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W4283755748