1
|
Danesh V, Tellson A, Boehm LM, Stevens AB, Ogola GO, Shrestha A, Cho J, Jimenez EJ, Arroliga AC. Exploring the Association of Metabolic Syndrome with In-Hospital Survival of Older Patients Hospitalized with COVID-19: Beyond Chronological Age. J Gen Intern Med 2024; 39:1811-1819. [PMID: 38587729 PMCID: PMC11282001 DOI: 10.1007/s11606-024-08744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. OBJECTIVE To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. DESIGN AND PARTICIPANTS This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. EXPOSURE ICU admission and/or in-hospital mortality. MAIN MEASURES Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. KEY RESULTS Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. CONCLUSIONS Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.
Collapse
Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Alaina Tellson
- Nursing Research, Baylor Scott & White Health, Dallas, TX, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan B Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gerald O Ogola
- Biostatistics, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Anisha Shrestha
- Data Core, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Alejandro C Arroliga
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Baylor Scott & White Health, Dallas, TX, USA
| |
Collapse
|
2
|
Mohamed Taha A, Adel Abdelkader Saed S, Hossam-Eldin Moawad M, Abd El-Tawab Moawad W, Al-Hejazi T, Mousa Y, Sharma R, Reiter RJ. Safety and efficacy of melatonin as an adjuvant therapy in COVID-19 patients: Systematic review and meta-analysis. Adv Med Sci 2023; 68:341-352. [PMID: 37742478 DOI: 10.1016/j.advms.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Melatonin might be beneficial to coronavirus disease 2019 (COVID-19) patients in terms of both prevention and treatment. We investigated how melatonin affected various clinical and laboratory results in COVID-19 patients. METHODS PubMed, Scopus, Cochrane Library and Web of Science databases were utilized for searching eligible articles fulfilling our inclusion criteria up to December 2022. We used random effect model in case of significant heterogeneity; in other cases, a fixed model was applied. RevMan was used for meta-analysis. RESULTS We included 11 studies in our review. Clinical improvement rate was found to be statistically significantly higher in patients taking melatonin than in the control group (OR: 5.09; 95% CI: 2.60-9.96, p < 0.001). Patients receiving melatonin showed a non-significant difference in mortality rate compared to the control group (OR: 0.37; 95% CI: 0.07-1.81, p = 0.22). However, in the randomized controlled trials subgroup, melatonin-treated patients showed significantly lower mortality than did the controls (OR: 0.17; 95% CI: 0.08-0.38, p < 0.001). CRP level was statistically significantly lower due to melatonin treatment (weighted mean difference [WMD] = -9.85; 95% CI: -18.54 to -1.16, p = 0.03). Length of hospital stay was statistically significantly shorter in patients taking melatonin compared to controls (WMD = -4.05; 95% CI: -5.39 to -2.7, p < 0.001). CONCLUSION Melatonin was found to have substantial effects on COVID-19 patients when used as adjuvant therapy, enhancing clinical improvement and decreasing time to recovery with a shorter length of hospital stay and a shorter duration of mechanical ventilation.
Collapse
Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt; Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
| | | | - Mostafa Hossam-Eldin Moawad
- Clinical Department, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Tala Al-Hejazi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Yosra Mousa
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
| |
Collapse
|
3
|
de Hesselle ML, Borgmann S, Rieg S, Vehreschild JJ, Rasch S, Koll CEM, Hower M, Stecher M, Ebert D, Hanses F, Schumann J. Age and Comorbidity Burden of Patients Critically Ill with COVID-19 Affect Both Access to and Outcome of Ventilation Therapy in Intensive Care Units. J Clin Med 2023; 12:jcm12072469. [PMID: 37048553 PMCID: PMC10095412 DOI: 10.3390/jcm12072469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient's age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient's wishes.
Collapse
Affiliation(s)
- Marie Louise de Hesselle
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, 85049 Ingolstadt, Germany
| | - Siegbert Rieg
- Department of Medicine II, University of Freiburg, 79106 Freiburg, Germany
| | - Jörg Janne Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, 60323 Frankfurt, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Carolin E M Koll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, 44137 Dortmund, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Daniel Ebert
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Julia Schumann
- University Clinic and Outpatient Clinic for Anesthesiology and Operative Intensive Care, University Medicine Halle (Saale), 06112 Halle (Saale), Germany
| |
Collapse
|
4
|
Bouetard L, Flamand T, Vignes D, Robert A, Sterpu R, Lemonnier L, Mion M, Gerber V, Abgrall S, Martinot M. High-flow cannula for frail patients with SARS-CoV-2 infection non-eligible for intensive care unit management. Infect Dis Now 2023; 53:104635. [PMID: 36436803 PMCID: PMC9686049 DOI: 10.1016/j.idnow.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/22/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-flow nasal cannula (HFNC) was widely used during the COVID-19 pandemic in intensive care units (ICU), but there is no recommendation for elderly patients non-eligible for ICU management. We aimed to describe the outcomes of HFNC treatment in patients with COVID-19 who are not eligible for ICU management. METHODS Retrospective bicentric cohort study performed between September 1, 2020 and June 30, 2021 in two infectious diseases departments of Colmar Hospital and Antoine Beclere University Hospital, France. RESULTS Sixty-four patients were treated with HFNC: 33 in Colmar and 31 in Beclere hospital (median age: 85 years; IQ, 82-92). Of these, 16 patients survived (25%). Surviving patients had a lower Charlson comorbidity index score than deceased patients (five vs six; p = 0.02). CONCLUSIONS Despite a high death rate, with survivors being younger and having fewer comorbidities, HFNC is an easy tool to implement in non-ICU wards for the frailest patients.
Collapse
Affiliation(s)
- L Bouetard
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France; Université Paris-Saclay, UVSQ, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - T Flamand
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - D Vignes
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France
| | - A Robert
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - R Sterpu
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France
| | - L Lemonnier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M Mion
- Geriatrics Department, Antoine Béclère University Hospital, APHP, Paris, France
| | - V Gerber
- Intensive Care Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Abgrall
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France; Université Paris-Saclay, UVSQ, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - M Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France.
| |
Collapse
|
5
|
Fabre I, Tardieu L, Ouissa R, Mounsamy L, Chahim B, Roger PM. Severe COVID-19 Pneumonia in Elderly Patients: Success Rate of Compassioned Use of High Flow Nasal Cannula Therapy. Aging Dis 2023; 14:1-5. [PMID: 36818557 PMCID: PMC9937705 DOI: 10.14336/ad.2022.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Isabelle Fabre
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Laurène Tardieu
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Rachida Ouissa
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Ludwig Mounsamy
- Gérontologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Bassel Chahim
- Service Post-urgence, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France
| | - Pierre-Marie Roger
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.,Faculté de Médecine, Université des Antilles, Guadeloupe, France.,Correspondence should be addressed to: Pr. Pierre-Marie Roger, Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Pointe-à-Pitre, 97110, Guadeloupe, France.
| |
Collapse
|
6
|
Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort. J Clin Med 2022; 11:jcm11061544. [PMID: 35329870 PMCID: PMC8951481 DOI: 10.3390/jcm11061544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.
Collapse
|
7
|
Melatonin: highlighting its use as a potential treatment for SARS-CoV-2 infection. Cell Mol Life Sci 2022; 79:143. [PMID: 35187603 PMCID: PMC8858600 DOI: 10.1007/s00018-021-04102-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Numerous pharmaceutical drugs have been repurposed for use as treatments for COVID-19 disease. These drugs have not consistently demonstrated high efficacy in preventing or treating this serious condition and all have side effects to differing degrees. We encourage the continued consideration of the use of the antioxidant and anti-inflammatory agent, melatonin, as a countermeasure to a SARS-CoV-2 infection. More than 140 scientific publications have identified melatonin as a likely useful agent to treat this disease. Moreover, the publications cited provide the rationale for the use of melatonin as a prophylactic agent against this condition. Melatonin has pan-antiviral effects and it diminishes the severity of viral infections and reduces the death of animals infected with numerous different viruses, including three different coronaviruses. Network analyses, which compared drugs used to treat SARS-CoV-2 in humans, also predicted that melatonin would be the most effective agent for preventing/treating COVID-19. Finally, when seriously infected COVID-19 patients were treated with melatonin, either alone or in combination with other medications, these treatments reduced the severity of infection, lowered the death rate, and shortened the duration of hospitalization. Melatonin’s ability to arrest SARS-CoV-2 infections may reduce health care exhaustion by limiting the need for hospitalization. Importantly, melatonin has a high safety profile over a wide range of doses and lacks significant toxicity. Some molecular processes by which melatonin resists a SARS-CoV-2 infection are summarized. The authors believe that all available, potentially beneficial drugs, including melatonin, that lack toxicity should be used in pandemics such as that caused by SARS-CoV-2.
Collapse
|
8
|
Abulseoud OA, Yehia A, Egol CJ, Nettey VN, Aly M, Qu Y, Skolnik AB, Grill MF, Sen A, Schneekloth TD. Attenuated initial serum ferritin concentration in critically ill coronavirus disease 2019 geriatric patients with comorbid psychiatric conditions. Front Psychiatry 2022; 13:1035986. [PMID: 36440432 PMCID: PMC9681793 DOI: 10.3389/fpsyt.2022.1035986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
We examined the effects of psychiatric comorbidity, sex, and ICU admission on serum ferritin concentration in 628 elderly patients (79.7 ± 8.5 years) with positive SARS-CoV-2 PCR test. Hospitalization was required in 96% of patients and 17% required ICU admission. Patients with COVID-19 and psychiatric comorbidities (n = 212) compared to patients without psychiatric comorbidities (n = 416) had significantly lower ferritin concentration (570.4 ± 900.1 vs. 744.1 ± 965, P = 0.029), a greater incidence of delirium (22.6 vs. 14.4%, P = 0.013) and higher mortality (35.3 vs. 27.6%, P = 0.015). Furthermore, we found significant effects for sex (P = 0.002) and ICU admission (P = 0.007). Among patients without comorbid psychiatric conditions, males had significantly higher ferritin compared to females (1,098.3 ± 78.4 vs. 651.5 ± 94.4, P < 0.001). ICU patients without comorbid psychiatric conditions had significantly higher serum ferritin compared to ICU patients with comorbid psychiatric conditions: (1,126.6 ± 110.7 vs. 668.6 ± 156.5, P < 0.001). Our results suggest that the presence of comorbid psychiatric conditions in elderly patients with COVID-19 is associated with higher rates of delirium and mortality and lower ferritin levels during severe illness. Whether high serum ferritin is protective during severe infection requires further investigation.
Collapse
Affiliation(s)
- Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States.,Department of Neuroscience, Mayo Clinic Graduate School of Biomedical Sciences, Collaborative Research Building (CRB), Scottsdale, AZ, United States
| | - Asmaa Yehia
- Department of Medical Physiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Claudine J Egol
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Victor N Nettey
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Mohamed Aly
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Yihuai Qu
- Alix School of Medicine at Mayo Clinic, Phoenix, AZ, United States
| | - Aaron B Skolnik
- Department of Critical Care, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Marie F Grill
- Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Ayan Sen
- Department of Critical Care, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
| |
Collapse
|