Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID-19 patients.
Miguel Ángel Duarte-MillánNieves Mesa-PlazaMarta Guerrero-SantillánAlejandro Morales-OrtegaDavid Bernal-BelloAna I Farfán-SedanoVanessa García de Viedma-GarcíaLaura Velázquez-RíosBegoña Frutos-PérezCristina L De Ancos-AracilGuillermo Soria Fernández-LlamazaresMaría Toledano-MacíasRafael Cristóbal-BilbaoNuria Luquín-CiuroJorge Marrero-FrancésSara I Piedrabuena-GarcíaJosé A Satué-BartoloméSonia Gonzalo-PascuaMarta Rivilla-JiménezLorena Carpintero-GarcíaIbone Ayala-LarrañagaVirginia García-BermúdezCelia Lara-MontesÁlvaro R Llerena-RiofríoLuis RIvas-PradoStefan WalterAlmudena Escriba-BarcenaJuan V San Martín LópezJosé Manuel Ruiz-GiardínPublished in: Journal of medical virology (2021)
Coronavirus disease 2019 (COVID-19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID-19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03-1.22), alcohol consumption (HR 3.15, 95% CI: 1.27-7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36-5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18-18.62) or reservoir (HR 7.87, 95% CI: 3.37-18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23-0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01-0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53-1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID-19 disease. In this regard, several parameters might identify high-risk patients upon admission. Combined use of TCZ and CS could improve survival.
Keyphrases
- prognostic factors
- coronavirus disease
- end stage renal disease
- newly diagnosed
- sars cov
- ejection fraction
- chronic kidney disease
- type diabetes
- peritoneal dialysis
- rheumatoid arthritis
- cardiovascular events
- alcohol consumption
- risk factors
- cardiovascular disease
- stem cells
- machine learning
- coronary artery disease
- rheumatoid arthritis patients
- community dwelling
- patient reported outcomes
- patient reported
- acute care