Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study.
Acute respiratory distress syndrome
Aged
COVID-19
Mechanical ventilation
Mortality
Risk factors
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
received:
24
08
2023
accepted:
25
09
2024
medline:
27
10
2024
pubmed:
27
10
2024
entrez:
27
10
2024
Statut:
epublish
Résumé
Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS). This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021. A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented. The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
Sections du résumé
BACKGROUND
BACKGROUND
Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).
METHODS
METHODS
This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.
RESULTS
RESULTS
A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.
CONCLUSIONS
CONCLUSIONS
The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
Identifiants
pubmed: 39462358
doi: 10.1186/s12877-024-05411-5
pii: 10.1186/s12877-024-05411-5
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
878Informations de copyright
© 2024. The Author(s).
Références
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–23. https://doi.org/10.1016/s0140-6736(67)90168-7 .
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788.
doi: 10.1001/jama.2016.0291
pubmed: 26903337
ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33. https://doi.org/10.1001/jama.2012.5669 .
Zaccardelli DS, Pattishall EN. Clinical diagnostic criteria of the adult respiratory distress syndrome in the intensive care unit. Crit Care Med. 1996;24(2):247–51.
doi: 10.1097/00003246-199602000-00011
pubmed: 8605796
Nicholson KG. Clinical features of influenza. Semin Respir Infect. 1992;7(1):26–37.
pubmed: 1609165
Anesi GL, Jablonski J, Harhay MO, Atkins JH, Bajaj J, Baston C, et al. Characteristics, outcomes, and trends of patients with COVID-19–related critical illness at a learning health system in the United States. Ann Intern Med. 2021;174(5):613–21.
doi: 10.7326/M20-5327
pubmed: 33460330
Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep. 2021;11(1):4263.
doi: 10.1038/s41598-021-82862-5
pubmed: 33608563
pmcid: 7895917
Brown SM, Peltan ID, Barkauskas C, Rogers AJ, Kan V, Gelijns A, et al. What does acute respiratory distress syndrome mean during the COVID-19 pandemic? Ann Am Thorac Soc. 2021;18(12):1948–50.
doi: 10.1513/AnnalsATS.202105-534PS
pubmed: 34288834
pmcid: 8641820
Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93. https://doi.org/10.1056/NEJMoa050333 .
Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, Hernández M, Gea A, Arruti E, et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020;46(12):2200–11.
doi: 10.1007/s00134-020-06192-2
pubmed: 32728965
pmcid: 7387884
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052.
doi: 10.1001/jama.2020.6775
pubmed: 32320003
pmcid: 7177629
Rodriguez Lima DR, PinzónRondón ÁM, Rubio Ramos C, Pinilla Rojas DI, Niño Orrego MJ, Díaz Quiroz MA, et al. Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia. Int J Emerg Med. 2022;15(1):22.
doi: 10.1186/s12245-022-00426-4
pubmed: 35597911
pmcid: 9123834
Santus P, Radovanovic D, Saderi L, Marino P, Cogliati C, De Filippis G, et al. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ Open. 2020;10(10):e043651.
doi: 10.1136/bmjopen-2020-043651
pubmed: 33040020
pmcid: 7549463
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73.
doi: 10.1007/s00134-020-06294-x
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–81.
doi: 10.1016/S2213-2600(20)30079-5
pubmed: 32105632
pmcid: 7102538
Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669–77.
doi: 10.1016/S1473-3099(20)30243-7
pubmed: 32240634
pmcid: 7158570
Nikolich-Žugich J. The twilight of immunity: emerging concepts in aging of the immune system. Nat Immunol. 2018;19(1):10–9.
doi: 10.1038/s41590-017-0006-x
pubmed: 29242543
Abohelwa M, Peterson CJ, Landis D, Le D, Conde C, DeWare C, et al. Clinical Characteristics of Hospital Follow-up for Patients Hospitalized from SARS CoV-2 (COVID 19) in an Academic Outpatient Internal Medicine Clinic. J Prim Care Community Health. 2022;13:215013192211345.
doi: 10.1177/21501319221134560
Zeeh J, Memm K, Heppner HJ, Kwetkat A. Beatmung geriatrischer Patienten — ein ethisches Dilemma? : Corona-Pandemie 2020 [Covid-19 pandemic. Mechanical ventilation in geriatric patients - an ethical dilemma?]. MMW Fortschr Med. 2020;162(9):40–5. German. https://doi.org/10.1007/s15006-020-0475-y .
Smolin B, Raz-Pasteur A, Mashiach T, Zaidani H, Levi L, Strizevsky A, et al. Mechanical ventilation for older medical patients in a large tertiary medical care center. Eur Geriatr Med. 2022;13(1):253–65.
doi: 10.1007/s41999-021-00557-6
pubmed: 34542845
De Sire A, Moggio L, Marotta N, Agostini F, Tasselli A, Drago Ferrante V, et al. Impact of Rehabilitation on fatigue in post-COVID-19 patients: a systematic review and meta-analysis. Appl Sci. 2022;12(17):8593.
doi: 10.3390/app12178593
Tzotzos SJ, Fischer B, Fischer H, Zeitlinger M. Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey. Crit Care. 2020;24(1):516.
doi: 10.1186/s13054-020-03240-7
pubmed: 32825837
pmcid: 7441837
Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, et al. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. Am J Respir Crit Care Med. 2016;193(1):52–9.
doi: 10.1164/rccm.201503-0584OC
pubmed: 26352116
Ospina-Tascón GA, Calderón-Tapia LE, García AF, Zarama V, Gómez-Álvarez F, Álvarez-Saa T, et al. Effect of high-flow oxygen therapy vs conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19: a randomized clinical trial. JAMA. 2021;326(21):2161.
doi: 10.1001/jama.2021.20714
pubmed: 34874419
Yildirim S, Cinleti BA, Saygili SM, Senel E, Ediboglu O, Kirakli C. The effect of driving pressures in COVID-19 ARDS: Lower may still be better as in classic ARDS. Respir Investig. 2021;59(5):628–34.
doi: 10.1016/j.resinv.2021.06.002
pubmed: 34244106
pmcid: 8258546
Elsayed HH, Hassaballa AS, Ahmed TA, Gumaa M, Sharkawy HY, Moharram AA. Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis. Lazzeri C, editor. PLoS One. 2021;16(6):e0252760.
doi: 10.1371/journal.pone.0252760
pubmed: 34086779
pmcid: 8177443
Sagoschen I, Keller K, Wild J, Münzel T, Hobohm L. Case fatality of hospitalized patients with COVID-19 infection suffering from acute respiratory distress syndrome in Germany. Viruses. 2022;14(11):2515.
doi: 10.3390/v14112515
pubmed: 36423124
pmcid: 9695874
Brazier DE, Perneta N, Lithander FE, Henderson EJ. Prone Positioning of Older Adults with COVID-19: A Brief Review and Proposed Protocol. J Frailty Aging. 2022;11(1):115–20. https://doi.org/10.14283/jfa.2021.30 .
Gómez CC, Rodríguez ÓP, Torné ML, Santaolalla CE, Jiménez JFM, Fernández JG, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva Engl Ed. 2020;44(7):429–38.
Caser EB, Zandonade E, Pereira E, Gama AMC, Barbas CSV. Impact of distinct definitions of acute lung injury on its incidence and outcomes in Brazilian ICUs: prospective evaluation of 7,133 patients*. Crit Care Med. 2014;42(3):574–82.
doi: 10.1097/01.ccm.0000435676.68435.56
pubmed: 24158166
The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693–704.
doi: 10.1056/NEJMoa2021436
Jung C, Wernly B, Fjølner J, Bruno RR, Dudzinski D, Artigas A, et al. Steroid use in elderly critically ill COVID-19 patients. Eur Respir J. 2021;58(4):2100979.
doi: 10.1183/13993003.00979-2021
pubmed: 34172464
pmcid: 8246007
He Z, Yan R, Liu J, Dai H, Zhu Y, Zhang F, et al. Lactate dehydrogenase and aspartate aminotransferase levels associated with the severity of COVID-19: a systematic review and meta-analysis. Exp Ther Med. 2023;25(5):221.
doi: 10.3892/etm.2023.11920
pubmed: 37123202
pmcid: 10133797
Xie R, Weng C, Lin X, Han G, Shen H, Zhang J, et al. Predicting Covid-19 progression in elderly patients: the role of lactate dehydrogenase and D-Dimer. SSRN; 2023. Available from: https://www.ssrn.com/abstract=4455409 . [cited 2023 Nov 8].