ABSTRACT
In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) - 3.2%; 95% confidence interval (95% CI) - 4.4 to - 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD - 7.6%; 95% CI - 9.7 to - 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload.
Subject(s)
COVID-19 , Pandemics , Humans , Aged , Aged, 80 and over , Spain/epidemiology , COVID-19 Vaccines , Retrospective Studies , COVID-19/epidemiology , SARS-CoV-2 , RegistriesABSTRACT
OBJECTIVES: The aim of this study was to analyze whether subgroups of immunosuppressive (IS) medications conferred different outcomes in COVID-19. METHODS: The study involved a multicenter retrospective cohort of consecutive immunosuppressed patients (ISPs) hospitalized with COVID-19 from March to July, 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality. RESULTS: Out of 16 647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISPs. In the PSM model, ISPs had greater in-hospital mortality (OR 1.25, 95% CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95% CI 1.43-2.49). Other IS drugs had no repercussions with regard to mortality risk (including calcineurin inhibitors (CNI); OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model involving patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95% CI 1.43-3.82). CONCLUSIONS: Chronic IS therapies comprise a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid therapy is associated with increased mortality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes.
Subject(s)
COVID-19 Drug Treatment , Calcineurin Inhibitors , Adrenal Cortex Hormones/adverse effects , Calcineurin Inhibitors/adverse effects , Hospital Mortality , Humans , Registries , Retrospective Studies , SARS-CoV-2ABSTRACT
ANTECEDENTES Y OBJETIVO: El aumento en la esperanza de vida ha generado hospitalizaciones de pacientes con edades muy avanzadas. El objetivo de este trabajo es estudiar las características de la población de más de 90 años que ingresa por fracaso renal agudo (FRA) en comparación con otros grupos etarios. MATERIALES Y MÉTODOS: Estudio transversal que incluyó a todos los pacientes hospitalizados entre 2013 y 2014 cuya codificación al alta era de FRA. Recogimos características epidemiológicas, comorbilidad, medicación y datos analíticos basales. Analizamos y comparamos los datos de los mayores de 90 años con los menores de dicha edad. RESULTADOS: Se incluyeron 1.733 pacientes. Del total de pacientes, 264 (15%) tenían una edad superior a 90 años y se encontró una proporción significativamente mayor de mujeres. La causa más frecuente del FRA en los pacientes mayores de 90 años fue la funcional (81%) (p < 0,001 respecto al resto de grupos etarios). La principal causa de ingreso fue la infecciosa. En el grupo de más de 90 años, encontramos mayor prevalencia de hipertensión arterial (HTA) (p = 0,005), enfermedad renal crónica (ERC) (p = 0,014), insuficiencia cardiaca congestiva (ICC) (p = 0,006) y deterioro cognitivo (p < 0,0001). El filtrado glomerular basal por CKD-EPI fue inferior en el grupo de mayores de 90 años (p < 0,0001). Los pacientes hospitalizados por FRA menores de 90 años tenían mayor prevalencia de diabetes mellitus (p < 0,001), dislipemia (p < 0,001) y antecedente de neoplasia (p < 0,001), y un índice de Barthel superior (p < 0,0001). CONCLUSIONES: La causa más frecuente de FRA en nonagenarios es la funcional, presentando los pacientes más HTA, ERC, ICC, mayor dependencia y deterioro cognitivo frente al resto de grupos etarios
BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Renal Insufficiency/epidemiology , Comorbidity , Severity of Illness Index , Statistics, Nonparametric , Cross-Sectional Studies , Risk Factors , Acute Disease , Age FactorsABSTRACT
BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment.
