Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study
Alberto Frisoli Junior, Elaine Azevedo, Angela Tavares Paes, Eliene Lima, João Carlos Campos Guerra, Sheila Jean Mc Neill Ingham
BMC Geriatrics, doi:10.1186/s12877-022-02776-3
Background: The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID-19 remain unclear. Objective: To determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19. Method: This was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death.
Results: The mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03-9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99-8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21-33.88; 0.029)], and hemoglobin < 12 g/mL ; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation ; 0.001)], cancer history 0.026)] and IL-6 > 40 pg/ mL [OR:10.01 (1.66-60.13; 0.012)] were independent predictors of death.
Conclusion: In hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death.
Abbreviations 25(OH)D: 25-hydroxyvitamin-D; ALT: alanine transaminase; AST: aspartate aminotransferase; CKD: chronic kidney disease (non-hemodialysis); Creat: creatinine; CRP: C-reactive protein; CT: computed tomography; ESRD: end-stage renal disease (on HD); HD: hemodialysis; Hb: hemoglobin; ICU: intensive care units; IL: interleukin; LDH: lactate dehydrogenase; Myo: myoglobin; SRF/MV: severe respiratory failure with the need of mechanical ventilation; TLeuc: total leucocytes; TLymp: total lymphocytes; TNF: tumor necrosis factor.
Authors' contributions Accordance statement and authors' specific areas of contributions: Statements; All authors confirm authorship and participation in the preparation of the manuscript. This material has not been previously published, is not presently under consideration for publication elsewhere, nor will it be submitted elsewhere while it is under reviewed by your Journal. No other submissions or publications include material that is largely duplicative of that presented in the manuscript or derived from the same subjects. If accepted, the paper will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder. No references were blacked-out. The authors declare that they agree with all the statements presented in this manuscript. This manuscript had been read and approved by all authors. Authors' specific areas of contributions; AFJ, EA, SJMI,..
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