Journal Article

Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study

Anzueta Duarte, Jimmy Hadid, Rodriguez Lima, David Rene, Otálora González, Laura, Devia Jaramillo, German, Rubio Ramos, Cristhian, Pinilla Rojas, Darío Isaías, Gómez Cortés, Leonardo Andrés, Rodríguez Aparicio, Edith Elianna, Yepes Velasco, Andrés Felipe

2024

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute respiratory distress syndrome / Age Factors / Age groups / Aged / Aged patients / Aged, 80 and over / Aging / Care and treatment / Cohort Studies / Colombia - epidemiology / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - mortality / COVID-19 - therapy / Edema / Evaluation / Female / Geriatrics/Gerontology / Hospital care / Hospital Mortality - trends / Humans / L-Lactate dehydrogenase / Laboratories / Male / Mechanical ventilation / Mechanics / Medicine / Medicine & Public Health / Middle Aged / Mortality / Multivariate analysis / Older people / Ostomy / Pandemics / Patient outcomes / Pneumonia / Rehabilitation / Respiratory distress syndrome / Respiratory Distress Syndrome - mortality / Respiratory Distress Syndrome - therapy / Retrospective Studies / Risk Factors / SARS-CoV-2 / Severe acute respiratory syndrome / Statistical significance / Steroid hormones / Tracheotomy / Variance analysis / Ventilators