tetano
Editor, Senior Moderator
BMC Geriatr
. 2024 Oct 26;24(1):878.
doi: 10.1186/s12877-024-05411-5. Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study
David Rene Rodriguez Lima[SUP] 1 2 [/SUP], Jimmy Hadid Anzueta Duarte[SUP] 3 4 [/SUP], Cristhian Rubio Ramos[SUP] 5 [/SUP], Laura Otálora González[SUP] 4 [/SUP], Darío Isaías Pinilla Rojas[SUP] 5 [/SUP], Leonardo Andrés Gómez Cortés[SUP] 5 [/SUP], Edith Elianna Rodríguez Aparicio[SUP] 5 [/SUP], Andrés Felipe Yepes Velasco[SUP] 3 4 [/SUP], German Devia Jaramillo[SUP] 6 [/SUP]
Affiliations
Background: Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).
Methods: This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.
Results: A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.
Conclusions: The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
Keywords: Acute respiratory distress syndrome; Aged; COVID-19; Mechanical ventilation; Mortality; Risk factors.
. 2024 Oct 26;24(1):878.
doi: 10.1186/s12877-024-05411-5. Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study
David Rene Rodriguez Lima[SUP] 1 2 [/SUP], Jimmy Hadid Anzueta Duarte[SUP] 3 4 [/SUP], Cristhian Rubio Ramos[SUP] 5 [/SUP], Laura Otálora González[SUP] 4 [/SUP], Darío Isaías Pinilla Rojas[SUP] 5 [/SUP], Leonardo Andrés Gómez Cortés[SUP] 5 [/SUP], Edith Elianna Rodríguez Aparicio[SUP] 5 [/SUP], Andrés Felipe Yepes Velasco[SUP] 3 4 [/SUP], German Devia Jaramillo[SUP] 6 [/SUP]
Affiliations
- PMID: 39462358
- PMCID: PMC11515189
- DOI: 10.1186/s12877-024-05411-5
Background: Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).
Methods: This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.
Results: A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67-80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71-80 [OR 1.87 (95% CI 1.33-2.64)], age > 80 [OR 8.74 (95% CI 5.34-14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003-1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50-3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52-17.60)], and use of steroids [OR 1.49 (95% CI 1.09-2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67-14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.
Conclusions: The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.
Keywords: Acute respiratory distress syndrome; Aged; COVID-19; Mechanical ventilation; Mortality; Risk factors.