ABSTRACT
Objective To identify predictors of 30-day survival in elderly patients with COVID-19. Methods Retrospective cohort study including COVID-19 patients≥65 years old hospitalized in 6 European sites (January 2020-May 2021). Demographics, comorbidities, clinical characteristics and outcomes were collected. A predictive score (FLAMINCOV) was developed using logistic regression. Regression coefficients were used to calculate the score. External validationina cohort including elderly patients from a major COVID-19 center in Israel was performed. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC)in the derivation and validation cohorts. Survival risk groups based on the score were derived and applied to the validation cohort. Results Among 3010 patients included in the derivation cohort, 30-day survival was 74.5% (2242/3010). Intensive care unit (ICU) admission rate was 7.6% (228/3010).The model predicting survival included independent functional status (OR 4.87, 95%CI 3.93-6.03), SpO2/FiO2 ratio>235 (OR 3.75, 95%CI 3.04-4.63), C-reactive protein<14 mg/dl (OR 2.41, 95%CI 1.91-3.04), creatinine<1.3 (OR 2.02, 95%CI 1.62-2.52) mg/dl and absence of fever (OR 1.34, 95%CI 1.09-1.66). The score was validated in 1174 patients. The FLAMINCOV score ranges from 0 to 15 and showed good discrimination in the derivation (AUC 0.79, 95%CI 0.77–0.81, p<0.001) and validation cohort (AUC 0.79, 95%CI 0.76–0.81, p<0.001). Thirty-day survival ranged from 39.4% (203/515) to 95.3% (634/665)across four risk groups according to scorequartiles in the derivation cohort. Similar proportions were observed in the validation set.. Conclusions The FLAMINCOV score identifying elderly with higher or lower chances of survival may allow better triage and management, including ICU admission/exclusion.
ABSTRACT
The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients.Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs.The primary outcome was the time to nasopharyngeal swab negativization.A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization.Of 280 patients included, 59 (21.1%) patients were treated with steroids.Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p=0.023) or ≤100 mmHg (16.9% vs 12.7%; p=0.027), and length of hospitalization (20 vs 14 days; p<0.001).Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p=0.985).According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 >200 mmHg, and a lymphocyte count at admission >1.0*109/L. SARS-CoV-2 clearance was not associated with corticosteroid use.Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with early use of corticosteroids