Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID-19 patients.

Coronavirus disease 2019 (COVID-19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID-19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03-1.22), alcohol consumption (HR 3.15, 95% CI: 1.27-7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36-5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18-18.62) or reservoir (HR 7.87, 95% CI: 3.37-18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23-0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01-0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53-1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID-19 disease. In this regard, several parameters might identify high-risk patients upon admission. Combined use of TCZ and CS could improve survival.

[Red cell distribution width and mortality following hospital discharge in patients over 70 years of age]. / Ancho de distribución eritrocitario como predictor de mortalidad tras el alta hospitalaria en mayores de 70 años.

BACKGROUND AND OBJECTIVE: To examine whether red cell distribution width (RDW) performs as a mortality predictor after hospital discharge in patients over 70 years of age and if its prognostic power is superior to other laboratory parameters. PATIENTS AND METHODS: Longitudinal and prospective study of 426 patients admitted to the Internal Medicine Department who survived hospitalization. Sociodemographic and comorbidity factors, functional and cognitive status as well as disease parameters causing admission (diagnosis, analytical parameters, length of stay) were collected. Patients were followed for one year by telephone interview and data were collected regarding vital status and, if appropriate, death date. RDW effect on mortality was assessed using logistic regression and prognostic capability by the area under the ROC curve. RESULTS: Each percentage point rise in RDW was associated with increased mortality at one year with an odds ratio of 1.19 (95% confidence interval [95% CI] 1.08 to 1.31). Mortality in each tertile of RDW was 15.6% in the lowest, 21.5% in the middle and 30.5% in the highest. A clinical model supplemented with RDW improved mortality predictive ability assessed by ROC curve. Net reclassification improvement of the prediction rule was 1.71% (95% CI 0.07 to 3.35) p=0.04. CONCLUSION: This study provides new evidence of the RDW association with mortality in a cohort of elderly patients who survived hospitalization. RDW was the only laboratory parameter that improved the one-year prognostic mortality ability.

Ancho de distribución eritrocitario como predictor de mortalidad tras el alta hospitalaria en mayores de 70 años / Red cell distribution width and mortality following hospital discharge in patients over 70 years of age

Fundamento y objetivo: Analizar si el ancho de distribución eritrocitario (ADE) se comporta como factor pronóstico de mortalidad tras el alta hospitalaria en pacientes mayores de 70 años y si su capacidad pronóstica es superior a la de otros parámetros de laboratorio. Pacientes y método: Estudio longitudinal prospectivo en 426 pacientes ingresados en el Servicio de Medicina Interna que sobrevivieron a un ingreso hospitalario. Se recogieron variables sociodemográficas, comorbilidad, situación funcional, situación cognitiva y parámetros de la enfermedad que origina el ingreso (diagnóstico, parámetros analíticos, estancia). El seguimiento se realizó durante un año mediante entrevista telefónica, en la que se recogieron datos sobre la situación vital y, si procedía, fecha de fallecimiento. El efecto del ADE sobre la mortalidad se evaluó mediante regresión logística y su capacidad pronóstica mediante el área bajo la curva ROC. Resultados: Cada punto porcentual de incremento del ADE se asoció con una mayor mortalidad al año, con una odds ratio de 1,19 (intervalo de confianza del 95% [IC 95%] 1,08-1,31). La mortalidad en cada tercil del ADE fue 15,6% en el inferior, 21,5% en el intermedio y 30,5% en el más elevado. Un modelo clínico suplementado con el ADE mejora su capacidad predictora de mortalidad evaluada mediante curva ROC. La mejora de reclasificación neta de dicha predicción es del 1,71% (IC 95% 0,07-3,35) (p = 0,04). Conclusión: El presente estudio aporta nuevas evidencias de asociación del ADE con mortalidad en una cohorte de pacientes ancianos que sobreviven a un ingreso hospitalario. El ADE fue el único parámetro de laboratorio analizado que mejoraba la capacidad pronóstica de mortalidad a un año (AU)

Background and objective: To examine whether red cell distribution width (RDW) performs as a mortality predictor after hospital discharge in patients over 70 years of age and if its prognostic power is superior to other laboratory parameters. Patients and methods: Longitudinal and prospective study of 426 patients admitted to the Internal Medicine Department who survived hospitalization. Sociodemographic and comorbidity factors, functional and cognitive status as well as disease parameters causing admission (diagnosis, analytical parameters, length of stay) were collected. Patients were followed for one year by telephone interview and data were collected regarding vital status and, if appropriate, death date. RDW effect on mortality was assessed using logistic regression and prognostic capability by the area under the ROC curve. Results: Each percentage point rise in RDW was associated with increased mortality at one year with an odds ratio of 1.19 (95% confidence interval [95% CI] 1.08 to 1.31). Mortality in each tertile of RDW was 15.6% in the lowest, 21.5% in the middle and 30.5% in the highest. A clinical model supplemented with RDW improved mortality predictive ability assessed by ROC curve. Net reclassification improvement of the prediction rule was 1.71% (95% CI 0.07 to 3.35) p = 0.04. Conclusion: This study provides new evidence of the RDW association with mortality in a cohort of elderly patients who survived hospitalization. RDW was the only laboratory parameter that improved the one-year prognostic mortality ability (AU)