Mortalidad y factores pronósticos asociados en pacientes ancianos y muy ancianos hospitalizados con infección respiratoria COVID-19
Daniel Águila-Gordo, Jorge Martínez-Del Río, Virginia Mazoteras-Muñoz, Martín Negreira-Caamaño, Patricia Nieto-Sandoval Martín De La Sierra, Jesús Piqueras-Flores
Revista Española de Geriatría y Gerontología, doi:10.1016/j.regg.2020.09.006
Introducción: La población de mayor edad infectada por COVID-19 presenta una peor evolución clínica, siendo más susceptible a desarrollar manifestaciones graves. Las diferencias entre la población anciana y muy anciana, la mortalidad y los factores pronósticos asociados a la infección por SARS-CoV-2 no han sido suficientemente estudiados. Métodos: Registro observacional de 416 pacientes ancianos ingresados de forma consecutiva por infección respiratoria COVID-19 entre el 1 de marzo y el 30 abril de 2020 en el Hospital General Universitario de Ciudad Real. Se registraron variables clínicas y analíticas, intervenciones terapéuticas y desarrollo de eventos durante el ingreso y tras el alta hasta el 15 de junio de 2020, con el objetivo de analizar la mortalidad y factores pronósticos asociados. Resultados: La edad media fue de 84,43 ± 5,74 a ños. Los pacientes ancianos (entre 75 y 84 a ños) constituyeron un 50,2% de la muestra y los muy ancianos (≥ 85 a ños) el 49,8% restante. En el modelo de regresión de Cox multivariante, el riesgo de mortalidad fue mayor en pacientes muy ancianos (HR = 2,58; IC95%: 1,23-5,38; p = 0,01), hipertensos (HR = 3,45; IC95%: 1,13-10,5; p = 0,03) y con enfermedad renal crónica (HR = 3,86; IC95%: 1,3-11,43; p = 0,02). En cambio, la prescripción de calcioantagonistas (HR = 0,27; IC95%: 0,12-0,62; p = 0,002) y la terapia anticoagulante durante la hospitalización (HR = 0,26; IC95%: 0,08-0,83; p = 0,02) se asociaron con mayor tiempo libre de mortalidad. Conclusiones: Los pacientes muy ancianos, hipertensos y con enfermedad renal crónica presentaron mayor riesgo de mortalidad por infección respiratoria COVID-19. En cambio, el empleo de anticoagulación terapéutica y calcioantagonistas durante el ingreso se asociaron con mayor probabilidad de supervivencia en el seguimiento a corto plazo.
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