1
|
Ramos-Rincón JM, Pérez-Belmonte LM, Carrasco-Sánchez FJ, Jansen-Chaparro S, De-Sousa-Baena M, Bueno-Fonseca J, Pérez-Aguilar M, Arévalo-Cañas C, Bacete Cebrian M, Méndez-Bailón M, Fiteni Mera I, González García A, Navarro Romero F, Tuñón de Almeida C, Muñiz Nicolás G, González Noya A, Hernández Milian A, García García GM, Alcalá Pedrajas JN, Herrero García V, Corral-Gudino L, Comas Casanova P, Meijide Míguez H, Casas-Rojo JM, Gómez-Huelgas R. Cardiometabolic Therapy and Mortality in Very Old Patients With Diabetes Hospitalized due to COVID-19. J Gerontol A Biol Sci Med Sci 2021; 76:e102-e109. [PMID: 33945610 PMCID: PMC8135901 DOI: 10.1093/gerona/glab124] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Background The effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well-known. This work aims to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19. Methods We conducted a nationwide, multicenter, observational study in patients ≥80 years with type 2 diabetes mellitus hospitalized for COVID-19 between March 1 and May 29, 2020. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis were performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. Results Of the 2,763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (AOR 0.502, 95%CI 0.309-0.815, p=0.005) and angiotensin receptor blockers (AOR 0.454, 95%CI 0.274-0.759, p=0.003) were independent protectors against in-hospital mortality whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95%CI 1.092-2.842, p=0.020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins showed neutral association with in-hospital mortality. Conclusions We found important differences between cardiometabolic drugs and in-hospital mortality in older patients with type 2 diabetes mellitus hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers could reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors and statins seem to have a neutral effect; and acetylsalicylic acid could be associated with excess mortality.
Collapse
Affiliation(s)
| | - Luis M Pérez-Belmonte
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain
| | | | - Sergio Jansen-Chaparro
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain
| | | | - José Bueno-Fonseca
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain
| | - Maria Pérez-Aguilar
- Internal Medicine Department, Juan Ramón Jiménez University Hospital, Huelva, Spain
| | - Coral Arévalo-Cañas
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Marta Bacete Cebrian
- Internal Medicine Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, San Carlos Clinical Hospital, Complutense University, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Luis Corral-Gudino
- Internal Medicine Department, Río Hortega University Hospital, Regional Health Management of Castilla y Leon (SACYL), Valladolid University, Spain
| | | | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain
| | | |
Collapse
|
2
|
Ramos-Rincon JM, Buonaiuto V, Ricci M, Martín-Carmona J, Paredes-Ruíz D, Calderón-Moreno M, Rubio-Rivas M, Beato-Pérez JL, Arnalich-Fernández F, Monge-Monge D, Vargas-Núñez JA, Acebes-Repiso G, Mendez-Bailon M, Perales-Fraile I, García-García GM, Guisado-Vasco P, Abdelhady-Kishta A, Pascual-Pérez MDLR, Rodríguez-Fernández-Viagas C, Montaño-Martínez A, López-Ruiz A, Gonzalez-Juarez MJ, Pérez-García C, Casas-Rojo JM, Gómez-Huelgas R. Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 76:e28-e37. [PMID: 33103720 PMCID: PMC7797762 DOI: 10.1093/gerona/glaa243] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥ 80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1–May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. Results A total of 2772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index < 60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n: 1301) and increased with age (80–84 years: 41.6%; 85–90 years: 47.3%; 90–94 years: 52.7%; ≥95 years: 54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: oxygen saturation < 90%; temperature ≥ 37.8°C; quick sequential organ failure assessment (qSOFA) score ≥ 2; and unilateral–bilateral infiltrates on chest x-rays. Some analytical findings were independent risk factors for death, including estimated glomerular filtration rate < 45 mL/min/1.73 m2; lactate dehydrogenase ≥ 500 U/L; C-reactive protein ≥ 80 mg/L; neutrophils ≥ 7.5 × 103/μL; lymphocytes < 0.8 × 103/μL; and monocytes < 0.5 × 103/μL. Conclusions This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor preadmission functional status—not comorbidities—are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.
Collapse
Affiliation(s)
| | - Verónica Buonaiuto
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | - Michele Ricci
- Internal Medicine Department, Málaga Regional University Hospital, Spain
| | | | - Diana Paredes-Ruíz
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), Spain
| | | | | | | | | | | | | | - Isabel Perales-Fraile
- Internal Medicine Department, Infanta Sofía Hospital, S. S. de los Reyes, Madrid, Spain
| | | | - Pablo Guisado-Vasco
- Internal Medicine Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Spain
| | | | | | | | | | - Antonio López-Ruiz
- Internal Medicine Department, Axarquía Hospital, Vélez-Málaga, Málaga, Spain
| | | | - Cristina Pérez-García
- Internal Medicine Department, Do Salnes Hospital, Vilagarcía de Arousa (Pontevedra), Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
| | | | | |
Collapse
|