Factors Associated with COVID-19 Mortality in Elderly Patients in Intensive Care Unit

Yıl 2023, Cilt: 3 Sayı: 4, 117 - 122, 29.10.2023

Hüseyin Özkarakaş , İsmail Demir

https://doi.org/10.56016/dahudermj.1356852

Öz

Objectives: Mortality rates in patients with COVID-19 infection admitted to the intensive care unit are influenced by various factors. In this study, we aimed to investigate the mortality rate and factors affecting mortality in patients admitted to the intensive care unit due to COVID-19 infection who had not been vaccinated.
Methods: Our study was conducted retrospectively by scanning patients admitted to the intensive care unit of Izmir Bozyaka Education and Research Hospital of Health Sciences University from the beginning of 2020 to the end of 2022. Patients who were admitted to the intensive care unit were 65 years of age and older with COVID-19 infection. The patients' presenting complaints, degree of lung involvement, laboratory findings, and comorbidities were compared between patients who survived and those who passed away.
Results: A total of 166 patients were evaluated in our study. Of these, 48 patients were discharged, while 118 patients experienced an excitus. The median age (IQR) for discharged patients was 71.5 (8), and for patients who experienced an excitus, it was 78 (15), which was found to be statistically significant (p <0.001). The most common presenting complaint in all patients was high fever. Patients with two or more comorbidities were more common in the excitus group (p <0.001). Severe involvement on initial computed tomography was observed in 28 patients in the excitus group, while no severe involvement was seen in the discharged group (p <0.001).
Conclusion: Our study found that advanced age, extensive lung involvement at admission, the presence of two or more comorbidities, and the presence of dyspnea at admission were associated with increased mortality in elderly patients.

Anahtar Kelimeler

Covid-19, Elderly patients, Mortality

Kaynakça

• de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L, Fouchier RAM, Galiano M, Gorbalenya AE, Memish ZA, Perlman S, Poon LLM, Snijder EJ, Stephens GM, Woo PCY, Zaki AM, Zambon M, Ziebuhr J. Commentary: Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group. J Virol. 2013;87(14):7790-7792. doi:10.1128/JVI.01244-13
• Drosten C, Günther S, Preiser W, van der Werf S, Brodt HR, Becker S, Rabenau H, Panning M, Kolesnikova L, Fouchier RAM, Berger A, Burguière AM, Cinatl J, Eickmann M, Escriou N, Grywna K, Kramme S, Manuguerra JC, Müller S, Rickerts V, Stürmer M, Vieth S, Klenk HD, Osterhaus ADME, Schmitz H, Doerr HW. Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome. New England Journal of Medicine. 2003;348(20):1967-1976. doi:10.1056/NEJMoa030747
• Kuiken T, Fouchier RA, Schutten M, Rimmelzwaan GF, van Amerongen G, van Riel D, Laman JD, de Jong T, van Doornum G, Lim W, Ling AE, Chan PK, Tam JS, Zambon MC, Gopal R, Drosten C, van der Werf S, Escriou N, Manuguerra JC, Stöhr K, Peiris JSM, Osterhaus AD. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. The Lancet. 2003;362(9380):263-270. doi:10.1016/S0140-6736(03)13967-0
• Doraiswamy S, Cheema S, Mamtani R. Older people and epidemics: a call for empathy. Age Ageing. 2020;49(3):493-493. doi:10.1093/ageing/afaa060
• Garnier‐Crussard A, Forestier E, Gilbert T, Krolak‐Salmon P. Novel Coronavirus (COVID‐19) Epidemic: What Are the Risks for Older Patients? J Am Geriatr Soc. 2020;68(5):939-940. doi:10.1111/jgs.16407
• Le Couteur DG, Anderson RM, Newman AB. COVID-19 Through the Lens of Gerontology. The Journals of Gerontology: Series A. 2020;75(9):e119-e120. doi:10.1093/gerona/glaa077
• Guillon A, Laurent E, Godillon L, Kimmoun A, Grammatico-Guillon L. Long-term mortality of elderly patients after intensive care unit admission for COVID-19. Intensive Care Med. 2021;47(6):710-712. doi:10.1007/s00134-021-06399-x
• Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
• Xu J, Yang X, Yang L, Zou X, Wang Y, Wu Y, Zhou T, Yuan Y, Qi H, Fu S, Liu H, Xia J, Xu Z, Yu Y, Li R, Ouyang Y, Wang R, Ren L, Hu Y, Xu D, Zhao X, Yuan S, Zhang D, Shang Y. Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China. Crit Care. 2020;24(1):394. doi:10.1186/s13054-020-03098-9
• Alshukry A, Ali H, Ali Y, Al-Taweel T, Abu-Farha M, AbuBaker J, Devarajan S, Dashti AA, Bandar A, Taleb H, Al Bader A, Aly NY, Al-Ozairi E, Al-Mulla F, Bu Abbas M. Clinical characteristics of coronavirus disease 2019 (COVID-19) patients in Kuwait. PLoS One. 2020;15(11):e0242768. doi:10.1371/journal.pone.0242768
• Haas LEM, de Lange DW, van Dijk D, van Delden JJM. Should we deny ICU admission to the elderly? Ethical considerations in times of COVID-19. Crit Care. 2020;24(1):321. doi:10.1186/s13054-020-03050-x
• Nachtigall I, Lenga P, Jóźwiak K, Thürmann P, Meier-Hellmann A, Kuhlen R, Brederlau J, Bauer T, Tebbenjohanns J, Schwegmann K, Hauptmann M, Dengler J. Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clinical Microbiology and Infection. 2020;26(12):1663-1669. doi:10.1016/j.cmi.2020.08.011
• Dres M, Hajage D, Lebbah S, Kimmoun A, Pham T, Béduneau G, Combes A, Mercat A, Guidet B, Demoule A, Schmidt M. Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study. Ann Intensive Care. 2021;11(1):77. doi:10.1186/s13613-021-00861-1
• Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. doi:10.1001/jama.2020.1585
• Leung C. Clinical features of deaths in the novel coronavirus epidemic in China. Rev Med Virol. 2020;30(3). doi:10.1002/rmv.2103
• Mehrdad R, Zahra K, Mansouritorghabeh H. Hemostatic System (Fibrinogen Level, D-Dimer, and FDP) in Severe and Non-Severe Patients With COVID-19: A Systematic Review and Meta-Analysis. Clinical and Applied Thrombosis/Hemostasis. 2021;27:107602962110109. doi:10.1177/10760296211010973
• Neethling C, Calligaro G, Miller M, Opie JJS. The evolution of clot strength in critically-ill COVID-19 patients: a prospective observational thromboelastography study. Thromb J. 2021;19(1):83. doi:10.1186/s12959-021-00331-5
• Guo Z, Sun L, Li B, Tian R, Zhang X, Zhang Z, Clifford SP, Liu Y, Huang J, Li X. Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth. 2021;35(2):389-397. doi:10.1053/j.jvca.2020.08.067
• Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS, China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032
• Bouck EG, Denorme F, Holle LA, Middelton EA, Blair AM, de Laat B, Schiffman JD, Yost CC, Rondina MT, Wolberg AS, Campbell RA. COVID-19 and Sepsis Are Associated With Different Abnormalities in Plasma Procoagulant and Fibrinolytic Activity. Arterioscler Thromb Vasc Biol. 2021;41(1):401-414. doi:10.1161/ATVBAHA.120.315338
• Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
• Lim ZJ, Subramaniam A, Ponnapa Reddy M, Blecher G, Kadam U, Afroz A, Billah B, Ashwin S, Kubicki M, Bilotta F, Curtis JR, Rubulotta F. Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis. Am J Respir Crit Care Med. 2021;203(1):54-66. doi:10.1164/rccm.202006-2405OC
• Simonsick EM, Meier HCS, Shaffer NC, Studenski SA, Ferrucci L. Basal body temperature as a biomarker of healthy aging. Age (Omaha). 2016;38(5-6):445-454. doi:10.1007/s11357-016-9952-8
• Castle SC, Norman DC, Yeh M, Miller D, Yoshikawa TT. Fever Response in Elderly Nursing Home Residents: Are the Older Truly Colder? J Am Geriatr Soc. 1991;39(9):853-857. doi:10.1111/j.1532-5415.1991.tb04450.x
• Güneş ÜY, Zaybak A. Does the body temperature change in older people? J Clin Nurs. 2008;17(17):2284-2287. doi:10.1111/j.1365-2702.2007.02272.x