Predictors of In-hospital Mortality in Elderly Unvaccinated Patients During SARS-CoV-2 Alpha Variants Epidemic

Overview

Journal Infect Prev Pract

Specialty Infectious Diseases

Date 2024 Feb 15

PMID 38357519

Authors

Zenya Saito

Shota Uchiyama

Saiko Nishioka

Kentaro Tamura

Nobumasa Tamura

Kazuyoshi Kuwano

Affiliations

Soon will be listed here.

Abstract

Background: COVID-19, caused by SARS-CoV-2, has caused a global pandemic. This study aimed to identify predictors of in-hospital mortality in unvaccinated elderly patients with COVID-19 by comparing various predictive factors between the survivors and non-survivors.

Methods: We retrospectively selected 132 unvaccinated patients aged over 65 years with COVID-19 at a hospital in Kanagawa, Japan, during SARS-CoV-2 Alpha variants epidemic. We compared the clinical characteristics, laboratory and radiological findings, treatment, and complications of the survivors and non-survivors. In logistic regression analysis, variables that were significant in the univariate analysis were subjected to multivariate analysis using the variable increase method.

Results: There were 119 and 13 patients in the survivor and non-survivor groups, respectively. Multivariate regression revealed increasing odds with the presence of ARDS and DIC (odd ratio (OR) = 16.35, 34.36; 0.002, 0.001, respectively) and prolonged hospital stay (OR = 1.17; 0.004).

Conclusions: We found the complications of ARDS and DIC and hospital length of stay to be independent predictors of in-hospital mortality in elderly unvaccinated patients with COVID-19. Establishing treatments and prevention methods for ARDS and DIC could result in lower mortality rates.

Citing Articles

Vaccines for the Elderly and Vaccination Programs in Europe and the United States.

Anastassopoulou C, Ferous S, Medic S, Siafakas N, Boufidou F, Gioula G Vaccines (Basel). 2024; 12(6).

PMID: 38932295 PMC: 11209271. DOI: 10.3390/vaccines12060566.

Identifying Mortality Predictors in Hospitalized COVID-19 Patients: Insights from a Single-Center Retrospective Study at a University Hospital.

Zahornacky O, Rovnakova A, Surimova M, Porubcin S, Jarcuska P Microorganisms. 2024; 12(5).

PMID: 38792861 PMC: 11124314. DOI: 10.3390/microorganisms12051032.

References

Beitler J, Shaefi S, Montesi S, Devlin A, Loring S, Talmor D . Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive Care Med. 2014; 40(3):332-41. PMC: 3976426. DOI: 10.1007/s00134-013-3194-3. View

Buising K, Thursky K, Black J, MacGregor L, Street A, Kennedy M . A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax. 2006; 61(5):419-24. PMC: 2111174. DOI: 10.1136/thx.2005.051326. View

Albitar O, Ballouze R, Ooi J, Sheikh Ghadzi S . Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract. 2020; 166:108293. PMC: 7332436. DOI: 10.1016/j.diabres.2020.108293. View

Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Imaizumi K . Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology. 2008; 13(5):731-5. DOI: 10.1111/j.1440-1843.2008.01329.x. View

Kasamatsu Y, Yamaguchi T, Kawaguchi T, Tanaka N, Oka H, Nakamura T . Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia. Respirology. 2011; 17(2):330-6. DOI: 10.1111/j.1440-1843.2011.02101.x. View

Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens Y, Avondo A . Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017; 317(3):301-308. DOI: 10.1001/jama.2016.20329. View

. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020; 5(4):536-544. PMC: 7095448. DOI: 10.1038/s41564-020-0695-z. View

Asakura H, Takahashi H, Uchiyama T, Eguchi Y, Okamoto K, Kawasugi K . Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J. 2016; 14:42. PMC: 5039801. DOI: 10.1186/s12959-016-0117-x. View

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z . Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020; 18(5):1094-1099. PMC: 9906401. DOI: 10.1111/jth.14817. View

10.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H . 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):475-481. PMC: 7102538. DOI: 10.1016/S2213-2600(20)30079-5. View

11.

Chalmers J, Crichton M, Goeminne P, Cao B, Humbert M, Shteinberg M . Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline. Eur Respir J. 2021; 57(4). PMC: 7947358. DOI: 10.1183/13993003.00048-2021. View

12.

Ding Z, Li G, Chen L, Shu C, Song J, Wang W . Association of liver abnormalities with in-hospital mortality in patients with COVID-19. J Hepatol. 2020; 74(6):1295-1302. PMC: 7749734. DOI: 10.1016/j.jhep.2020.12.012. View

13.

Toma T, Abu-Hanna A, Bosman R . Discovery and inclusion of SOFA score episodes in mortality prediction. J Biomed Inform. 2007; 40(6):649-60. DOI: 10.1016/j.jbi.2007.03.007. View

14.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

15.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View

16.

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y . Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020; 146(1):110-118. PMC: 7152876. DOI: 10.1016/j.jaci.2020.04.006. View

17.

Osterbur K, Mann F, Kuroki K, DeClue A . Multiple organ dysfunction syndrome in humans and animals. J Vet Intern Med. 2014; 28(4):1141-51. PMC: 4857933. DOI: 10.1111/jvim.12364. View

18.

Ji W, Wang W, Zhao X, Zai J, Li X . Cross-species transmission of the newly identified coronavirus 2019-nCoV. J Med Virol. 2020; 92(4):433-440. PMC: 7138088. DOI: 10.1002/jmv.25682. View

19.

Lambden S, Laterre P, Levy M, Francois B . The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019; 23(1):374. PMC: 6880479. DOI: 10.1186/s13054-019-2663-7. View

20.

Tabata S, Imai K, Kawano S, Ikeda M, Kodama T, Miyoshi K . Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis. Lancet Infect Dis. 2020; 20(9):1043-1050. PMC: 7292609. DOI: 10.1016/S1473-3099(20)30482-5. View