ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19
Guilhem Bousquet, Géraldine Falgarone, David Deutsch, Sophie Derolez, Marilucy Lopez-Sublet, François-Xavier Goudot, Khadaoudj Amari, Yurdagul Uzunhan, Olivier Bouchaud, Frédéric Pamoukdjian
Background: To assess factors associated with one-month mortality among older inpatients with Covid-19. Results: The mean age was 78 ± 7.8 years, 55.5% were men, CT scan lung damage was observed in 76% of the patients (mild 23%, moderate 38%, extensive 22%, and severe 7%). The mortality rate was 26%. Dependency/Activities of Daily Living (ADL) score ≤ 5/6, D-Dimers, LDH, and no anticoagulation by reference for curative were independently associated with one-month mortality. A score derived from the multivariate model showed good calibration and very good discrimination (Harrell's C index [95%CI] = 0.83 [0.79-0.87]). Conclusion: ADL-dependency, high serum levels of D-Dimers and LDH and the absence of anticoagulation were independently associated with one-month mortality among older inpatients with Covid-19. Methods: 108 consecutive older inpatients aged 65 and over with Covid-19 confirmed by RT-PCR and/or typical CT chest scan were prospectively included in a French single-centre cohort study from March to April 2020. A systematic geriatric assessment was performed. Covariates were lymphocyte count, serum levels of albumin, C-Reactive Protein, D-Dimers and Lactate Dehydrogenase (LDH), anticoagulation level, and exposure to the hydroxychloroquine and azithromycin combined therapy. Cox uni-and multivariate proportional-hazard regressions were performed to identify predictors of one-month mortality.
AUTHOR CONTRIBUTIONS Conception and design: GB, GF, OB, FP Acquisition, analysis, or interpretation of data: All authors Drafting the work: GB, GF, FP Final approval: All authors Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors
CONFLICTS OF INTEREST The authors have no conflicts of interest to disclose.
SUPPLEMENTARY MATERIALS Supplementary Tables Supplementary Table 1 . The Cumulative Illness Rating Scale for Geriatrics (CIRS(G)) [15] .
Disease
References
Angeli, Chouahnia, Canoui-Poitrine, Duchemann, Aparicio et al., Development, validation and clinical impact of a prediction model for 6-month mortality in older cancer patients: the GRADE, Aging,
doi:10.18632/aging.102876Bhatraju, Ghassemieh, Nichols, Kim, Jerome et al., Covid-19 in critically ill patients in the seattle region -case series, N Engl J Med,
doi:10.1056/NEJMoa2004500Chen, Dai, Mo, Li, Ma et al., Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study, J Gerontol A Biol Sci Med Sci,
doi:10.1093/gerona/glaa089Cheng, Papenburg, Desjardins, Kanjilal, Quach et al., Diagnostic Testing for Severe Acute Respiratory Syndrome-Related Coronavirus 2: A Narrative Review, Ann Intern Med,
doi:10.7326/M20-1301Clément, Nassif, Léger, Marchan, Development and contribution to the validation of a brief french version of the yesavage geriatric depression scale
Collins, Reitsma, Altman, Moons, Transparent reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement, J Clin Epidemiol,
doi:10.1016/j.jclinepi.2014.11.010Du, Liang, Yang, Wang, Cao et al., Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study, Eur Respir J,
doi:10.1183/13993003.00524-2020Ellis, Langhorne, Comprehensive geriatric assessment for older hospital patients, Br Med Bull,
doi:10.1093/bmb/ldh033Fried, Tangen, Walston, Newman, Hirsch et al., Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype, J Gerontol A Biol Sci Med Sci,
doi:10.1093/gerona/56.3.m146Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents,
doi:10.1016/j.ijantimicag.2020.105949Hamming, Timens, Bulthuis, Lely, Navis et al., Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis, J Pathol,
doi:10.1002/path.1570Ji, Zhang, Xu, Chen, Yang et al., Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score, Clin Infect Dis,
doi:10.1093/cid/ciaa414Klok, Kruip, Van Der Meer, Arbous, Gommers et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19, Thromb Res,
doi:10.1016/j.thromres.2020.04.013Kojima, Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis, Disabil Rehabil,
doi:10.1080/09638288.2016.1212282Lawton, Brody, Assessment of older people: self-maintaining and instrumental activities of daily living, Gerontologist
Li, Fang, Li, Pan, Qin et al., CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19), Eur Radiol,
doi:10.1007/s00330-020-06817-6Li, Xu, Yu, Wang, Tao et al., Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan, J Allergy Clin Immunol,
doi:10.1016/j.jaci.2020.04.006Mehta, Mehta, Girman, Adhikari, Johnson, Regression coefficient-based scoring system should be used to assign weights to the risk index, J Clin Epidemiol,
doi:10.1016/j.jclinepi.2016.03.031Miller, Paradis, Houck, Mazumdar, Stack et al., Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale, Psychiatry Res,
doi:10.1016/0165-1781(92)90005-nRaynaud-Simon, Revel-Delhom, Hébuterne, Nutrition, Program et al., Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly, Clin Nutr,
doi:10.1016/j.clnu.2010.12.003Sanchez, Benhamou, Bertoletti, Constant, Couturaud et al., Recommandations de bonne pratique pour la prise en charge de la maladie veineuse thromboembolique chez l'adulte. Version courte, Rev Mal Respir,
doi:10.1016/j.rmr.2019.01.003Shahid, Kalayanamitra, Mcclafferty, Kepko, Ramgobin et al., COVID-19 and older adults: what we know, J Am Geriatr Soc,
doi:10.1111/jgs.16472Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3
