1
|
de Almondes KM, Castro EDAS, Paiva T. Morbidities Worsening Index to Sleep in the Older Adults During COVID-19: Potential Moderators. Front Psychol 2022; 13:913644. [PMID: 35832914 PMCID: PMC9271867 DOI: 10.3389/fpsyg.2022.913644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.
Collapse
Affiliation(s)
- Katie Moraes de Almondes
- Department of Psychology and Postgraduate Program in Psychobiology, AMBSONO Sleep Clinic, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Katie Moraes de Almondes,
| | | | - Teresa Paiva
- CENC –Sleep Medicine Center, Lisbon, Portugal
- ISAMB – Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
2
|
Davidescu EI, Odajiu I, Tulbǎ D, Sandu CD, Bunea T, Sandu G, Mureşanu DF, Bǎlǎnescu P, Popescu BO. Prognostic Factors in COVID-19 Patients With New Neurological Manifestations: A Retrospective Cohort Study in a Romanian Neurology Department. Front Aging Neurosci 2021; 13:645611. [PMID: 34220483 PMCID: PMC8245846 DOI: 10.3389/fnagi.2021.645611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: The emerging Coronavirus Disease (COVID-19) pandemic caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a serious public health issue due to its rapid spreading, high mortality rate and lack of specific treatment. Given its unpredictable clinical course, risk assessment, and stratification for severity of COVID-19 are required. Apart from serving as admission criteria, prognostic factors might guide future therapeutic strategies. Aim: We aimed to compare clinical features and biological parameters between elderly (age ≥ 65 years) and non-elderly (age <65 years) patients with COVID-19 and new neurological symptoms/conditions. We also aimed to determine factors independently associated with all-cause in-hospital mortality. Methods: All consecutive patients with COVID-19 and new neurological symptoms/conditions admitted in our Neurology Department between April 1 and August 23, 2020 were enrolled in this observational retrospective cohort study. Patient characteristics such as demographic data, comorbidities, biological parameters, imaging findings and clinical course were recorded. All-cause in-hospital mortality was the main outcome, whereas COVID-19 severity, hospitalization duration and the levels of supplemental oxygen were the secondary outcomes. Results: One hundred forty-eight patients were included, out of which 54.1% were women. The average age was 59.84 ± 19.06 years and 47.3% were elderly, the majority having cardiovascular and metabolic comorbidities. In the elderly group, the most frequent neurological symptoms/manifestations responsible for hospitalization were stroke symptoms followed by confusion, whereas in the non-elderly, headache prevailed. The final neurological diagnosis significantly varied between the two groups, with acute cerebrovascular events and acute confusional state in dementia most commonly encountered in the elderly (65.71 and 14.28%, respectively) and secondary headache attributed to SARS-CoV-2 infection often experienced by the non-elderly (38.46%). The elderly had statistically significant higher median values of white blood cell (8,060 vs. 6,090/μL) and neutrophil count (6,060 vs. 4,125/μL), C-reactive protein (29.2 vs. 5.72 mg/L), ferritin (482 vs. 187 mg/dL), fibrinogen (477 vs. 374 mg/dL), D-dimer (1.16 vs. 0.42), prothrombin time (151.15 vs. 13.8/s), aspartate transaminase (26.8 vs. 20.8 U/l), creatinine (0.96 vs. 0.77 mg/dL), and blood urea nitrogen level (51.1 vs. 27.65 mg/dL), as well as lower median value of hemoglobin (13.05 vs. 13.9 g/dL) and lymphocyte count (1,245 vs. 1,670/μL). Moreover, advanced age was significantly associated with more extensive lung involvement (25 vs. 10%) and higher fatality rate (40 vs. 9%). Overall, the mortality rate was 23.6%. Age as well as neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels were independently associated with mortality. Conclusions: Older age, higher neutrophil count, C-reactive protein, fibrinogen, and activated partial thromboplastin time levels are independent predictors of mortality in COVID-19 patients with new neurological manifestations/conditions at admission.
Collapse
Affiliation(s)
- Eugenia Irene Davidescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania.,Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Odajiu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Delia Tulbǎ
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania.,Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Colentina-Research and Development Center, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Teodora Bunea
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Georgiana Sandu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Dafin Fior Mureşanu
- Department of Neurosciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paul Bǎlǎnescu
- Colentina-Research and Development Center, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Research Unit RECIF (Reseau d'Epidemiologie Clinique International Francophone), Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania.,Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Laboratory of Cell Biology, Neurosciences and Experimental Myology, "Victor Babeş" National Institute of Pathology, Bucharest, Romania
| |
Collapse
|
3
|
Hospitalization Outcomes and Mortality Predictors of SARS-Cov-2 Infection in the Elderly: A Single Center Experience from India. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.112397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: This study aimed to assess the outcome and mortality predictors of SARS-CoV-2 infection requiring hospitalization among elderly population. Methods: In this retrospective study, hospitalized elderly people with virologically confirmed SARS-CoV-2 infection were evaluated. Participants were divided into three groups of mild, moderate, and severe based on oxygenation. The primary outcome was death or discharge to home. Results: A total of 169 patients were studied (mean age: 68 years). Apart from respiratory symptoms, other reported symptoms included gastrointestinal complaints in 11% (n = 19), acute stroke in 1.1% (n = 2), delirium in 1.7% (n = 3), and anosmia or ageusia in 8.88% (n = 15). Also, 65 (38.5%) patients required oxygen support, 25 (14.7%) were admitted to the intensive care unit (ICU), 7 (4.1%) required non-invasive ventilation (Fio2 0.6 to 1.0), 14 (8.28%) were mechanically ventilated. 72 (42%) received steroid, and 100 (59%) received prophylactic heparin. Overall mortality was 12.4% (n = 21). Gender had no effect on mortality (P = 0.83). Presence of ≥ 3 risk factors, elevated neutrophil lymphocyte ratio, D-dimer, and lactate dehydrogenase, were associated with mortality (P = 0.001, P = 0.0005, P = 0.05, and P = 0.0005, respectively). Sepsis and cardiovascular events were higher among those who died. Conclusions: We observed a low mortality among the elderly treated with steroids compared to studies done in the pre-steroid period. Elevated NLR, LDH, and D-dimer were associated with mortality.
Collapse
|
4
|
Mei Q, Wang AY, Bryant A, Yang Y, Li M, Wang F, Du S, Kurts C, Wu P, Ma K, Wu L, Chen H, Luo J, Li Y, Hu G, Yuan X, Li J. Survival Factors and Metabolic Pathogenesis in Elderly Patients (≥65) With COVID-19: A Multi-Center Study. Front Med (Lausanne) 2021; 7:595503. [PMID: 33585504 PMCID: PMC7873923 DOI: 10.3389/fmed.2020.595503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Elderly patients infected with COVID-19 are reported to be facing a substantially increased risk of mortality. Clinical characteristics, treatment options, and potential survival factors remain under investigation. This study aimed to fill this gap and provide clinically relevant factors associated with survival of elderly patients with COVID-19. Methods: In this multi-center study, elderly patients (age ≥65 years old) with laboratory-confirmed COVID-19 from 4 Wuhan hospitals were included. The clinical end point was hospital discharge or deceased with last date of follow-up on Jul. 08, 2020. Clinical, demographic, and laboratory data were collected. Univariate and multivariate analysis were performed to analyze survival and risk factors. A metabolic flux analysis using a large-scale molecular model was applied to investigate the pathogenesis of SARS-CoV-2 with regard to metabolism pathways. Results: A total of 223 elderly patients infected with COVID-19 were included, 91 (40.8%) were discharged and 132 (59.2%) deceased. Acute respiratory distress syndrome (ARDS) developed in 140 (62.8%) patients, 23 (25.3%) of these patients survived. Multivariate analysis showed that potential risk factors for mortality were elevated D-Dimer (odds ratio: 1.13 [95% CI 1.04 - 1.22], p = 0.005), high immune-related metabolic index (6.42 [95% CI 2.66–15.48], p < 0.001), and increased neutrophil-to-lymphocyte ratio (1.08 [95% 1.03–1.13], p < 0.001). Elderly patients receiving interferon atmotherapy showed an increased probability of survival (0.29 [95% CI 0.17–0.51], p < 0.001). Based on these factors, an algorithm (AlgSurv) was developed to predict survival for elderly patients. The metabolic flux analysis showed that 12 metabolic pathways including phenylalanine (odds ratio: 28.27 [95% CI 10.56–75.72], p < 0.001), fatty acid (15.61 [95% CI 6.66–36.6], p < 0.001), and pyruvate (12.86 [95% CI 5.85–28.28], p < 0.001) showed a consistently lower flux in the survivors vs. the deceased subgroup. This may reflect a key pathogenic mechanism of COVID-19 infection. Conclusion: Several factors such as interferon atmotherapy and recreased activity of specific metabolic pathways were found to be associated with survival of elderly patients. Based on these findings, a survival algorithm (AlgSurv) was developed to assist the clinical stratification for elderly patients. Dysregulation of the metabolic pathways revealed in this study may aid in the drug and vaccine development against COVID-19.
Collapse
Affiliation(s)
- Qi Mei
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Amanda Y Wang
- The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia.,Concord Clinical School, The University of Sydney, Newtown, NSW, Australia.,Department of Renal Medicine, Concord Repatriation General Hospital, Newtown, NSW, Australia
| | - Amy Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID, United States
| | - Yang Yang
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Li
- Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Fei Wang
- Department of Chinese Medicine, Tongji Medical College, Wuhan No. 1 Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shangming Du
- Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Patrick Wu
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wu
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Huawen Chen
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jinlong Luo
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Li
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyuan Hu
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Yuan
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Li
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| |
Collapse
|
5
|
Mei Q, Wang AY, Bryant A, Yang Y, Li M, Wang F, Zhao JW, Ma K, Wu L, Chen H, Luo J, Du S, Halfter K, Li Y, Kurts C, Hu G, Yuan X, Li J. Development and validation of prognostic model for predicting mortality of COVID-19 patients in Wuhan, China. Sci Rep 2020; 10:22451. [PMID: 33384422 PMCID: PMC7775455 DOI: 10.1038/s41598-020-78870-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022] Open
Abstract
Novel coronavirus 2019 (COVID-19) infection is a global public health issue, that has now affected more than 200 countries worldwide and caused a second wave of pandemic. Severe adult respiratory syndrome-CoV-2 (SARS-CoV-2) pneumonia is associated with a high risk of mortality. However, prognostic factors predicting poor clinical outcomes of individual patients with SARS-CoV-2 pneumonia remain under intensive investigation. We conducted a retrospective, multicenter study of patients with SARS-CoV-2 who were admitted to four hospitals in Wuhan, China from December 2019 to February 2020. Mortality at the end of the follow up period was the primary outcome. Factors predicting mortality were also assessed and a prognostic model was developed, calibrated and validated. The study included 492 patients with SARS-CoV-2 who were divided into three cohorts: the training cohort (n = 237), the validation cohort 1 (n = 120), and the validation cohort 2 (n = 135). Multivariate analysis showed that five clinical parameters were predictive of mortality at the end of follow up period, including advanced age [odds ratio (OR), 1.1/years increase (p < 0.001)], increased neutrophil-to-lymphocyte ratio [(NLR) OR, 1.14/increase (p < 0.001)], elevated body temperature on admission [OR, 1.53/°C increase (p = 0.005)], increased aspartate transaminase [OR, 2.47 (p = 0.019)], and decreased total protein [OR, 1.69 (p = 0.018)]. Furthermore, the prognostic model drawn from the training cohort was validated with validation cohorts 1 and 2 with comparable area under curves (AUC) at 0.912, 0.928, and 0.883, respectively. While individual survival probabilities were assessed, the model yielded a Harrell's C index of 0.758 for the training cohort, 0.762 for the validation cohort 1, and 0.711 for the validation cohort 2, which were comparable among each other. A validated prognostic model was developed to assist in determining the clinical prognosis for SARS-CoV-2 pneumonia. Using this established model, individual patients categorized in the high risk group were associated with an increased risk of mortality, whereas patients predicted to be in the low risk group had a higher probability of survival.
Collapse
Affiliation(s)
- Qi Mei
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Amanda Y Wang
- The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Clinical School, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Amy Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA
| | - Yang Yang
- Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Ming Li
- Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, Hubei, People's Republic of China
| | - Fei Wang
- Department of Chinese Medicine, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jia Wei Zhao
- The Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Liang Wu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Huawen Chen
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jinlong Luo
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shangming Du
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kathrin Halfter
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Yong Li
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Guangyuan Hu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Xianglin Yuan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Jian Li
- Institute of Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| |
Collapse
|
6
|
Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, Komici K, Mazzarella G, Parrella R, Bianco A. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res 2020; 32:1599-1608. [PMID: 32557332 PMCID: PMC7298699 DOI: 10.1007/s40520-020-01631-y] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.
Collapse
Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Grazia Mazzeo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| | - Matilde Boccia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Gennaro Mazzarella
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Roberto Parrella
- COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| |
Collapse
|