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Journal of the American Geriatrics Society ; 69(SUPPL 1):S101, 2021.
Article in English | EMBASE | ID: covidwho-1214846


Background: Frailty is a syndrome characterized by vulnerability to stressors resulting from multisystemic loss of physiological reserve associated with poor clinical outcomes. Recent studies have shown worse outcomes and higher mortality rate in older adults with COVID 19 infection. The risk for mortality may be even higher in hospitalized older adults with coexistent frailty and COVID 19 infection. The FI-LAB is a validated, objective measure of frailty in acute care settings which is based on laboratory values and vital signs. The study aim was to assess the FI-LAB score as a predictor of inpatient mortality in Veterans admitted with COVID-19 Infection. Methods: Retrospective cohort study conducted in a population of veterans admitted with COVID-19 infection to 7 VISN 8 acute care facilities across Florida. We calculated the 31-item FI-LAB using laboratory values and vital signs upon admission. Veterans were categorized as low (<0.25), moderate (0.25-0.40), and high (>0.40) based on FI-LAB scores. Differences in inpatient mortality among the 3 FI-LAB groups were determined using a Cox regression model, adjusted for age, BMI, gender, race, and ethnicity. Results: 700 patients were hospitalized, mean age 66.03 (range:22-103, SD=14.86) years, Caucasian 58.14% (n=407), non-Hispanic 81.71% (n=572), and 93.86% (n=657) male. According to the FI-LAB, 47.42% (n=332), 43.85% (n=307), and 8.71% (n=61) were in the low, moderate and high groups, respectively. There were 53 total inpatient deaths (<65, n=6, 11.32% and ≥65 years, n=47, 88.68%): FI-LAB low 10 (3.01%), moderate 3 (10.09%), high 12 (19.67%), p<.0005. The median follow up was 5 days (IQR=12). As compared with the low FI-LAB group, Veterans in the moderate and high groups had higher mortality risk, adjusted hazard ratio (HR)=2.87 (95%CI:1.36-6.06), p=0.006 and HR=5.23 (95%CI:2.10-13.06), respectively, p<.005. Conclusions: Moderate and higher FI-LAB groups were associated with higher inpatient mortality than the low category. Most deaths were among older adults. The FI-LAB may identify patients at higher mortality risk and assist clinicians in the development of early strategies to reduce mortality in hospitalized older patients with frailty and COVID 19 infection.

The Journal of Heart and Lung Transplantation ; 40(4, Supplement):S143-S144, 2021.
Article in English | ScienceDirect | ID: covidwho-1141792


Purpose The respiratory system, and namely the lung, is undoubtedly the preferential target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical pictures are extremely various, up to the intensive care unit (ICU) admission for acute respiratory distress syndrome (ARDS). Lung transplantation (LT) is a consolidate therapeutic option for end-stage chronic respiratory diseases. Its role in an acute setting is questionable, particularly due to lack of experiences, donor shortage, and the difficulty to fully evaluate the potential recipient. We report our preliminary experience with the first two cases of LT for SARS-CoV-2 related ARDS, trying to provide some food for thought. Methods We retrospectively analysed our first two cases of bilateral LT for ARDS after COVID-19. We recorded data on pre-transplantation clinical course, transplantation management and outcomes. Results The two patients had a similar clinical evolution of COVID-19. Transplantations were successful in both cases;the first patient is alive and in good condition 5 months after transplantation, while the second died 62 days after surgery. Table 1 shows clinical details and relevant time-points. Conclusion Our experience showed that LT for COVID-19 is feasible. Importantly, observing a dedicated protocol made the procedure safe for the healthcare staff involved. On the other hand, our second unsuccessful case poses relevant questions: first of all, lung transplantation should be reserved to highly selected patient, after careful clinical, infective as well as psychiatric evaluation. The ethical aspects should also be considered in this situation, with regard to the centre rate mortality on waiting list. Anyway, the potential role of LT in the acute and sub-acute/chronic settings suggests the need for maintaining LT centre active during pandemic. Finally, COVID-19, once more, imposes to share clinical experiences.