Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis
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Published:2023-09-06
Issue:9
Volume:11
Page:2473
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ISSN:2227-9059
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Container-title:Biomedicines
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language:en
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Short-container-title:Biomedicines
Author:
Spannella Francesco12ORCID, Giulietti Federico1, Laureti Giorgia12, Di Rosa Mirko3ORCID, Di Pentima Chiara1, Allevi Massimiliano12, Garbuglia Caterina12, Giordano Piero1, Landolfo Matteo12, Ferrara Letizia4, Fumagalli Alessia5ORCID, Lattanzio Fabrizia6, Bonfigli Anna Rita6ORCID, Sarzani Riccardo12ORCID
Affiliation:
1. Internal Medicine and Geriatrics, IRCCS INRCA, 60127 Ancona, Italy 2. Department of Clinical and Molecular Sciences, “Politecnica delle Marche” University, 60126 Ancona, Italy 3. Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60127 Ancona, Italy 4. Medical Direction, Risk Manager, IRCCS INRCA, 60127 Ancona, Italy 5. Pulmonary Rehabilitation Unit, IRCCS INRCA, 23880 Casatenovo, Italy 6. Scientific Direction, IRCCS INRCA, 60127 Ancona, Italy
Abstract
Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83–91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28–3.01)] and 3 [HR 2.87 (95% CI: 1.62–5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient.
Subject
General Biochemistry, Genetics and Molecular Biology,Medicine (miscellaneous)
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